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University of Tennessee, Knoxville Trace: Tennessee Research and Creative Exchange Masters Theses Graduate School 5-2008 Comparing the Quality of Language Samples Obtained under Three Sampling Conditions from Children with Hearing Impairment Katie E. Stilwell University of Tennessee - Knoxville Recommended Citation Stilwell, Katie E., "Comparing the Quality of Language Samples Obtained under Three Sampling Conditions from Children with Hearing Impairment. " Master's Thesis, University of Tennessee, 2008. http://trace.tennessee.edu/utk_gradthes/457 This Thesis is brought to you for free and open access by the Graduate School at Trace: Tennessee Research and Creative Exchange. It has been accepted for inclusion in Masters Theses by an authorized administrator of Trace: Tennessee Research and Creative Exchange. For more information, please contact [email protected]. To the Graduate Council: I am submitting herewith a thesis written by Katie E. Stilwell entitled "Comparing the Quality of Language Samples Obtained under Three Sampling Conditions from Children with Hearing Impairment." I have examined the final electronic copy of this thesis for form and content and recommend that it be accepted in partial fulfillment of the requirements for the degree of Master of Arts, with a major in . Ilsa Schwarz, Major Professor We have read this thesis and recommend its acceptance: Mark Hedrick, Seunghee Ha Accepted for the Council: Dixie L. Thompson Vice Provost and Dean of the Graduate School (Original signatures are on file with official student records.) To the Graduate Council: I am submitting herewith a thesis written by Katie Ellen Stilwell entitled “Comparing the Quality of Language Samples Obtained under Three Sampling Conditions from Children with Hearing Impairment.” I have examined the final electronic copy of this dissertation for form and content and recommend that it be accepted in partial fulfillment of the requirements for the degree of Master of Arts, with a major in Speech Pathology. ______________________________ Ilsa Schwarz PhD CCC-SLP Major Professor We have read this thesis and recommend its acceptance: ___________________________ Mark Hedrick ___________________________ Seunghee Ha ____________________________ Carolyn R. Hodges, Vice Provost and Dean of the Graduate School (Original signatures are on file with official student records.) COMPARING THE QUALITY OF LANGUAGE SAMPLES OBTAINED UNDER THREE SAMPLING CONDITIONS FROM CHILDREN WITH HEARING IMPAIRMENT A Thesis Presented for the Master of Arts Degree The University of Tennessee, Knoxville Katie Ellen Stilwell May 2008 ii ABSTRACT Objective: To determine if there was an optimal language sampling context for children with hearing impairment; specifically, if any well-documented method of obtaining a language sample was superior to the others in describing the areas of language that are known to serve as a foundation for later literacy development. Participants: Nine children with hearing impairment who used oral language as their primary mode of communication from the University of Tennessee Child Hearing Services clinic were selected to participate in the study. All were from Caucasian families who spoke English as their primary language and with the exception of hearing impairment, none had other documented disorders. Method: Three language samples were taken in an interview, picture description and story retell format during one 50 minute session. Data Analysis: The language samples were analyzed for syntax and morphology, semantic, pragmatic and narrative measures which are preliteracy factors that influence later literacy acquisition. Results: A battery of language samples is needed in order to appropriately access multiple elements of language relating to literacy acquisition of children with hearing impairment. Conclusion: Through the analysis of this study, it has been determined that in order to get a comprehensive view of language in hearing impaired children who use oral language as their primary communication, a battery of language assessments should be used. iii ACKNOWLEDGEMENTS I would like to thank everyone who helped me complete my Master of Arts Thesis. My greatest appreciation goes to Dr. Ilsa Schwarz for leading me through the process of choosing a focus, obtaining data, and creating this document. We‟ve spent countless hours brainstorming and revising. I would also like to thank the others on my committee, Dr. Mark Hedrick and Dr. Seunghee Ha for collaborating with me, and attending my defense. Thank you to all the Child Hearing Services supervisors and families for lending me their clients and children for my research. I wouldn‟t have had a study without them! Finally, I would like to express my gratitude to my friends and family for supporting me through this entire process. From phone calls of encouragement to dinners and advice concerning the project, I couldn‟t have done this without you! iv TABLE OF CONTENTS CHAPTER 1 ....................................................................................................................... 1 INTRODUCTION .............................................................................................................. 1 The Importance of Language to Later Literacy Skills .................................................... 1 Hearing Impairment ........................................................................................................ 4 The Acquisition of Literacy Skills in Children who are Hearing Impaired .................... 5 CHAPTER 2 ....................................................................................................................... 8 REVIEW OF THE LITERATURE .................................................................................... 8 Language and Literacy Acquisition of Children with Hearing Impairment ................... 8 Language Sample Analysis ........................................................................................... 10 Freeplay..................................................................................................................... 11 Interview ................................................................................................................... 11 Picture Description.................................................................................................... 13 Story retell ................................................................................................................. 13 Comparison of Language Sampling Techniques .......................................................... 14 Language Sample Analysis ........................................................................................... 15 Syntax and Morphology ......................................................................................... 16 Semantics .................................................................................................................. 17 Pragmatics ................................................................................................................. 19 Narrative Development of Children with Hearing Impairment .................................... 19 CHAPTER 3 ..................................................................................................................... 22 METHODS ....................................................................................................................... 22 Participants .................................................................................................................... 22 v Materials ....................................................................................................................... 24 Procedures ..................................................................................................................... 24 Condition I- Interview............................................................................................... 25 Condition II- Picture Description.............................................................................. 26 Condition III- Story Retell with Manipulatives ........................................................ 26 Data Analysis ................................................................................................................ 27 CHAPTER 4 ..................................................................................................................... 28 RESULTS ......................................................................................................................... 28 Within Subject Analysis ............................................................................................... 30 Syntax and Morphology – Mean Length of Utterance ............................................. 30 Syntax and Morphology – Morpheme Development................................................ 31 Syntax and Morphology – Utterance Level Errors ................................................... 32 Semantics – Type-Token Ratio ................................................................................. 34 Semantics – Frequency of Word Errors .................................................................... 34 Pragmatics ................................................................................................................. 34 Narrative Analysis .................................................................................................... 36 Between Subject Analysis............................................................................................. 39 Syntax and Morphology............................................................................................ 39 Semantics .................................................................................................................. 40 Pragmatics ................................................................................................................. 42 Narrative Analysis .................................................................................................... 43 CHAPTER 5 ..................................................................................................................... 45 DISCUSSION AND CONCLUSION .............................................................................. 45 vi Syntax and Morphology................................................................................................ 45 Semantics ...................................................................................................................... 46 Pragmatics ..................................................................................................................... 47 Narrative Development ................................................................................................. 48 Conclusions ................................................................................................................... 48 Limitations .................................................................................................................... 49 Implications for Further Research ................................................................................ 50 REFERENCES ................................................................................................................. 52 APPENDICES .................................................................................................................. 59 Appendix A ................................................................................................................... 60 Appendix B ................................................................................................................... 62 Appendix C ................................................................................................................... 63 Appendix D ................................................................................................................... 64 Appendix E ................................................................................................................... 65 Appendix F.................................................................................................................... 66 Appendix G ................................................................................................................... 67 Appendix H ....................................................................................................................... 69 Subject Analysis................................................................................................................ 69 Appendix I ........................................................................................................................ 88 Narrative Subject Scoring Descriptions ............................................................................ 88 VITA ................................................................................................................................. 91 vii LIST OF TABLES Table 1. Degrees of Hearing Loss..................................................................................... 5 Table 2. Normal Range of NDW and NTW in 100-Utterance Speech Samples of Children Between 5-11 Years (Paul, 2001, p.422). .......................................................... 18 Table 3. Subject Hearing Background. ............................................................................. 23 Table 4. Total Elicitation Time for Each Context By Subject. ........................................ 29 Table 5. Average Times for Each Elicitation Technique. ................................................ 29 Table 6. Number of Subject Utterances (in T-Units) by Context within 10 Minutes. .... 30 Table 7. Within Subject Analysis MLU in Words and Morphemes. ............................... 31 Table 8 Within Subject Analysis of Brown's Stages of Morpheme Development. .......... 32 Table 9 Number of Bound Morphemes in Error According to Sampling Condition ....... 33 Table 10. Within Subject Analysis: Utterance Level Errors............................................ 33 Table 11. Within Subject Analysis: NDW, NTW, and TTR. .......................................... 35 Table 12 Within Subject Analysis: Frequency of Word Error and Word Omissions By Elicitation Context ............................................................................................................ 36 Table 13. Within Subject Analysis: Ratio of Child (C) and Examiner (E) Total Utterances in T-Units. ....................................................................................................... 37 Table 14. Within Subject Analysis: Narrative Ranking.................................................. 38 Table 15. Between Subject Analysis: Total Sentence Type by Greatest Frequency. ...... 39 Table 16. Between Subject Analysis: Average Number of Omitted Bound Morphemes by Elicitation Context. ...................................................................................................... 40 Table 17. Between Subject Analysis: Average TTR by Elicitation Context .................... 41 viii Table 18 Between Subject Analysis: Total Word Type by Greatest Frequency. ............. 41 Table 19. Between Subject Analysis: Average Number of Word Error and Word Omission Frequency by Context....................................................................................... 42 Table 20. Between Subject Analysis: Average Number of Utterance Level Errors by Context .............................................................................................................................. 42 Table 21. Between Subject Analysis: Pragmatic Skills as Measured by Turn-Taking ... 42 Table 22. Between Subject Narrative Analysis: Comparison by Number of Subjects per Ranking ............................................................................................................................. 44 ix LIST OF FIGURES Figure 1. Adam's (1990) Model of the Reading Process (based on Seidenberg & McClelland, 1989). ............................................................................................................. 9 Figure 2. van Kleeck's Model of Literacy Acquisition (2007). ....................................... 10 Figure 3. Adaptation of McFadden's Holistic Narrative Classification System (1997). . 21 Figure 4. Taken from Paul (2001) Box 11-1 Story Grammar (p. 392). ........................... 26 x LIST OF ABBREVIATIONS CHS- Child Hearing Services dB HL- decibels Hearing Level MLU- Mean Length of Utterance NDW- Number of Different Words NTW- Number of Total Words TTR- Type Token Ratio 1 CHAPTER 1 INTRODUCTION Over the past several decades, research has provided increasing evidence of the crucial role language plays in the reading process. At present, reading and writing are considered to be language-based skills that use visual input as an entrance into the language-processing system (Catts and Kamhi, 1999; Snowling and Stackhouse, 1996; Vellutino, 1979). Understanding the role that language plays in the acquisition of literacy skills is particularly important when working with children who do not develop language skills in a typical manner. For those children who struggle with language acquisition, the assessment of all components of language known to underpin literacy development is crucial. Specifically, obtaining an accurate picture of their language skills and language deficits allows the clinician to create appropriate educational goals in order to prevent or ameliorate reading impairments. It has also been shown that studying language in a contextualized manner is of great importance for measuring functional language levels (Paul, 2001). The Importance of Language to Later Literacy Skills One reason that understanding a child‟s language system is so important is the role language plays in providing the foundation for later academic performance. Paul (2001) discusses the relationship between spoken language and literacy and the ways in which language skills predict future literacy success. She states that “understanding a written text requires all the linguistic knowledge about the content, form and use of language that is required for understanding speech” (p. 398). She elaborates on the 2 relationship between spoken and written language comprehension by stating “If reading is a language-based skill, then this implies that understanding meaning through reading makes use of all the same processes used to extract meaning from oral language” (p. 397). Paul‟s comments suggest that language sample measures can be used to predict literacy skills in children. Language samples provide evidence of language comprehension by examining the child‟s ability to answer questions, maintain a topic, and tell a story. They also assess language production through elicitation of syntax, semantics, and pragmatics. In an effort to more accurately describe the language system that underpins literacy skills, researchers and practitioners must conduct comprehensive language assessments. These assessments need to include some means of determining which, if any, components of language that lead to later literacy are impaired. Roth et al. (2002) conducted a longitudinal study in order to examine which elements of language predicted successful reading in first and second graders. Their study concluded that among other aspects, semantic knowledge and narrative discourse were relevant predictors of reading, especially in the first grade. Semantic knowledge and syntax, as well as other elements of language, are commonly elicited from children in two ways: spontaneous language samples and more highly structured tasks such as formal tests and elicited imitation tasks. Studies have shown that the relationship between language elicited during formal tasks and language produced during spontaneous speech tasks reveal that the more highly structured elicitations do not always predict children‟s actual spontaneous performance (Maxwell, 1997). Observations made during highly structured tasks not occurring within the context 3 of natural discourse are invalid for measuring the child‟s primary communicative skills. These elicitations may underestimate the child‟s true receptive and expressive language skills and provide little useful information regarding the child‟s conversation skills. Research has shown that in order to get the best representation of a child‟s true language abilities and accurately describe a child‟s language system, the use of language sampling is critical (Blau, Lahey, & Oleksiuk-Velez, 1984). Spontaneous language samples provide a more natural means of assessing syntactic, semantic and discourse skills used by children in their daily life (Evans & Craig, 1992). It is recognized that a variety of sampling conditions may be used to describe a child‟s language system. To obtain a complete picture of a child‟s language abilities, it is important that their semantics, syntax, conversational discourse and understanding of narrative structures are assessed. Semantics and syntax (including morphology) must be evaluated in order to determine if their vocabulary and sentence complexity are ageappropriate. Conversational discourse and narrative development need to be assessed in order to look for problems in pragmatics or skills specific to early literacy. Narrative analysis is different from conversational analysis in that narratives have a single speaker instead of a conversational exchange as in standard oral language; however, within the narrative a dialogue can be found between characters and will show some of the informalities of conversation. As a result, narrative samples are meant to “cover the middle ground between familiar oral language styles and more difficult literate forms” (Westby, 1991). This suggests that analyzing a child‟s narrative abilities can give predictors of both oral language and literate language (Paul, 2001). 4 Hearing Impairment Hearing impairment is defined as an “abnormality of structure or function of the hearing mechanism that is physiological, psychological or anatomical” (Martin & Clark, 2006). There are three types of hearing loss: conductive hearing loss, sensorineural hearing loss, and mixed hearing loss. Conductive hearing loss occurs from an obstruction or abnormality in the outer or middle ear that prevents air attenuation to travel throughout the hearing mechanism. Sensorineural hearing loss results from abnormality or damage to the inner ear such as the cochlea, hair cells or auditory nerve (Martin & Clark, 2006). The third type of hearing loss, mixed hearing loss, results from a combination of a conductive and sensorineural hearing loss. Hearing loss can be classified by severity (see Table 1 for description). Amplification is a common recommendation for children with hearing loss. The use of amplification typically involves a hearing aid. Hearing aids come in a variety of shapes, sizes and fits. The purpose of hearing aids is to increase loudness of sounds through amplification of the acoustic signal from the environment and deliver it directly to the ear. Individuals who have a conductive hearing loss or sensorineural hearing loss are those who benefit from hearing aids. However, most conductive losses can be medically or surgically treated; therefore, most children wearing hearing aids have a sensorineural loss. For individuals who are not able to derive the great benefit from hearing aids, cochlear implants may be recommended. Cochlear implants work differently than hearing aids. 5 Table 1. Degrees of Hearing Loss. Mild Hearing Loss Moderate Hearing Loss Severe Hearing Loss Profound Hearing Loss 20-40 dB HL 40-60 dB HL 60-90 dB HL 90 + dB HL ( adapted from www.agbell.org) They are surgically implanted into the cochlea and send signals directly to the auditory nerve via electrical signal. They are usually recommended for individuals with severe or severe to profound sensorineural hearing losses. Throughout their lives, children with hearing impairments, particularly those with the most severe hearing deficits, will struggle with educational, social and occupational challenges as they learn to use and understand spoken language. Even with the use of hearing aids or cochlear implants, children with hearing impairment will require additional support to overcome the hearing deficit. For this reason, it is recommended that children enter early intervention for hearing, speech and language as soon as possible (Yoshinaga-Itano, 2003). Their struggle can be lessened by therapy that appropriately targets their specific needs. In order to provide the most appropriate intervention, their specific areas of deficit must be well understood. The Acquisition of Literacy Skills in Children who are Hearing Impaired It is known that children who are deaf and hard of hearing have difficulty acquiring literacy skills. Typically, children who are deaf graduate from high school functionally illiterate, reading and writing on a 3rd to 4th grade level (Allen, 1986; Kretschmer & Kretchmer, 1978; Waters & Doehring, 1990). One factor that contributes to this reading deficit is that children who are hearing impaired experience a longer 6 preverbal period that delays their spoken language skills and relates to delays in literacy acquisition (Mogford-Bevan & Summersall, 1997). Studies have shown that children who are deaf and hard of hearing are often at a disadvantage when it comes to both contextualized and decontextualized language testing and should be tested in multiple contexts to obtain representative data. (Maxwell, 1997). Unfortunately, little information is available that describes the use of language sampling with children who are hearing impaired. It is important to know the true scope of language use and understanding of children with cochlear implants and hearing aids in order to appropriately design therapy and help them to reach their full potential for success in academics, social life, and career. Although language sampling is recommended as the best means of obtaining a profile of a child‟s language abilities, there is no consensus on the best method of obtaining a language sample (among others- Evans & Craig, 1992; Washington et al., 1998; Westerveld & Gillon, 2002). In the absence of well-documented procedural recommendations, the techniques used to elicit language samples may affect the quantity and quality of the information obtained (Hux, et al., 1993). When language samples are not an accurate representation of the child‟s skills, therapy may begin at a too basic level and rob the child of immediate gains that could be made if therapy began at a more advanced level. The opposite could occur if therapy began at a too advanced level, leaving the child discouraged and making little progress. Neither outcome is desirable. In summary, if aspects of language including syntax, semantics, conversational discourse and narrative development are not assessed at the time of an evaluation, an important indicator of the child‟s deficits and delays may be missed. The therapy 7 program created for the child will not be optimal for the child‟s language development skills due to that missing link and the child will continue to be behind normal-hearing peers. For this reason, the purpose of this study was to determine the best method of obtaining a language sample with hearing impaired children so that clinicians and educators are able to get the best representative sample of a child‟s language abilities that underpin later academic achievement. This study investigated three methods of language sampling to determine which resulted in optimal language output for predicting literacy skills. These sample types included picture description, clinician-child interview, and story retell with manipulatives. 8 CHAPTER 2 REVIEW OF THE LITERATURE Language and Literacy Acquisition of Children with Hearing Impairment At present, there is some controversy in the literature regarding what specific language or cognitive skills need to be assessed in order to create a profile of a child‟s language use, particularly as it relates to the language needed for later literacy development (Oakhill & Cain, 2000, Gough & Tunmer, 1986). Adams (1990) created a model for the acquisition of literacy with four main components: the context processor, meaning processor, orthographic processor and phonological processor. In this model, all parts are interactive and necessary for successful literacy development. Within Adams (1990) model, the orthographic and phonological processors work together to establish individual letter knowledge and print awareness. The meaning and context processors are involved in vocabulary knowledge and text interpretation for meaning. According to van Kleeck (1998), “Adams (1990) emphasizes the coordinated, parallel, and highly interactive nature of the various processors involved in reading. They work together and cannot replace, preempt, or overcome each other. She strongly advocates equal emphasis on form and meaning of print” (p. 34). This study‟s focus is on the later two processors: meaning and context. In order to understand the importance of the link between language sample measures and literacy development, one must understand the relationship between language and literacy learning. van Kleeck (2007) presented a model, adapted from he 9 Context Processor Meaning Processor Orthographic Processor Phonological Processor Print Speech Figure 1. Adam's (1990) Model of the Reading Process (based on Seidenberg & McClelland, 1989). earlier work by Adams (1990) that demonstrates the need for preliteracy skills in order to gain literacy skills (Figure 2). Preliteracy skills begin with letter knowledge and phonemic awareness and progress to decoding skills while vocabulary, semantic and syntactic skills, and inferencing develop into story comprehension and finally into reading comprehension (van Kleeck, 2007). By analyzing language samples, the preliteracy skills that determine depth of language and literacy understanding and production can be assessed. In Adam‟s model, these would be represented in the context and meaning processors. In van Kleeck‟s more detailed model, these skills include vocabulary, syntax (including morphology), 10 Figure 2. van Kleeck's Model of Literacy Acquisition (2007). inferencing, story and text comprehension, and school talk. For young children, particularly those with delays in language, the primary areas of interest will include vocabulary, syntax and story and text comprehension. Skills related to school talk and inferencing would be of greater concern in older children. For children who are hearing impaired, it may be more difficult to elicit their highest level of language knowledge and production due to their overall delays in language understanding that may impede the process. However, the understanding of these children‟s language comprehension and production abilities is critical in preparing them for literacy success. There is currently little research on the best, most effective way to assess the language and preliteracy skills of children who are hearing impaired and use spoken language as their primary form of communication. Language Sample Analysis A number of different methods have been used to elicit language samples from children. These samples run the range from child-directed (Craig & Washington, 2000) to 11 teacher-directed (Westerveld & Gillon, 2002), unscripted to scripted (Evans & Craig, 1992), using toys selected by the child (Crystal et al., 1976) or specific assessment materials used in a more standardized manner (Greenwood, Carta, Walker, Hughes, & Weathers, 2006) Freeplay Freeplay is a form of spontaneous language assessment where language is typically elicited through freeplay and child-directed activities. The examiner provides the toys and the subject chooses which toys to play with, while the subject and examiner play and talk with one another (Craig & Washington, 2000; Dunn et al, 1996; Gavin & Giles, 1996; Washington Craig, & Kusmaul, 1998). Another method of free play language sampling is through observing caregiver-child interaction (cf. Scott & Taylor, 1978). While free play allows for more subject creativity, which is good, this method of language sampling is very time consuming and has been found to be less effective than more direct methods (Evans & Craig, 1992; Fujiki & Willbrand, 1982). There is little pressure for the subject to speak and it is difficult to elicit multiple syntactic forms and complex language (Dollaghan et al., 1990). Because this language sample elicitation method has been found to be time consuming and less effective than other contexts, the principal investigator chose not to use this technique in the present study. Interview An interview format provides another context for spontaneous language assessment. This method is more structured than freeplay but allows for the child to give spontaneous responses to the clinician‟s probes. This strategy is more commonly used 12 with older children, but may also be effective with younger children. Variability and distractive factors are decreased with the use of this more structured method, cutting down on the time necessary to collect an appropriate sample (Evans & Craig, 1992). Evans and Craig (1992) conducted a study examining the effectiveness of the interview context versus the freeplay context for language sampling in children with specific language impairment (SLI). The two language samples taken from each child were analyzed for structural characteristics, conversational characteristics and adult behaviors. Results showed that children produced more utterances with longer sentence lengths, and produced more semantically and syntactically complex language within the interview context. In addition, children‟s responses to the examiner were more adjacent and contingent in the interview context than during freeplay. The Evans and Craig (1992) study concluded that both freeplay and interview contexts were successful in eliciting a diverse set of vocabulary even though the interviews were potentially more topically constrained. In conversation, intentional acts recorded for the two contexts were very similar. Excluding requests, other speech acts including comments, answers, and requests for clarification were comparable for both. Generally, interviews elicited all of the behaviors observed during freeplay, providing evidence that the interview method offers a representative context for language assessment. Despite the similarities of both assessments, the interview seemed to be a more reliable context due to the fact that the behaviors elicited during the interviews were more consistent and elicited language more often (nearly twice the amount) than in the freeplay context. The interview method proved, in this study, to be a valid, reliable and efficient 13 method to elicit spontaneous language without requiring large amounts of time or eliminating conversational validity (Evans & Craig, 1992). Picture Description Picture description is a moderately structured task for collecting language samples . This context is often used with younger children in preschool and the early years of elementary school. It has proven to be ecologically valid and gives the examiner more control over elicited conversation (Washington et al., 1998). Picture description tasks have the capacity to elicit monologue (Craig & Gallagher 1979; Gallagher & Craig, 1978), narrative structure (Scollon & Scollon, 1981; Stein & Glenn, 1979; Sutton-Smith, 1986; Westby, 1984) and scripts (Johnston, 1982; Nelson, 1981) consistent with younger children‟s natural language structures. Washington et al. (1998) compared a picture description task with a freeplay task for language elicitation in normally developing children who spoke African American English (AAE). Their results showed that picture description elicited more sentence types more frequently than in the freeplay assessment and took significantly less time to elicit 50 utterances than in the freeplay context. Picture description also proved to result in fewer adult utterances in relation to child utterances meaning a better conversational exchange was taking place. The results of their study reinforce the effectiveness of a picture description task for language sample collection. Story retell The story retell context for generating language samples consists of telling the subject a story then having the subject repeat the story (Merritt & Liles, 1987). The 14 stories can be analyzed for story grammar and structure as well as examining other aspects of language including syntax, semantics, and pragmatics. It has been found that even in retell tasks, children with language delays produce less complex and less organized story sequences. This indicates that story retell tasks are useful for examining multiple language structures as well as story grammar since language impaired children did not use story grammar, semantics, or syntactic forms with which they were not familiar (Merritt & Liles, 1987). Comparison of Language Sampling Techniques The literature has provided some research describing how different elicitation techniques might impact the results of a language sample with typically hearing children. In a study by Westerveld and Gillon (2002), the accuracy and suitability of a standard Language Sampling Protocol for low socioeconomic status, normally-developing children from New Zealand and Pacific Island backgrounds was examined. The methods of language sampling they used involved conversational language, personal narratives, and story retell. The results found that the Language Sampling Protocol was an appropriate method for eliciting child language for analysis and that the children in the study used more words and more complex sentences in narrative contexts than in conversation. In a related study by Westerveld and Gillon (1999-2000) optimal language sampling conditions and elicitation techniques when sampling children‟s oral narrative abilities were examined. The conditions examined for story retell included familiarity and exposure to the information discussed, contextual support before and during story 15 retell and linguistic complexity and story length of the stimulus story. Personal narratives, conversational maps and direct interviewing were used to elicit samples. It was also found that the child should be given at least three opportunities to give a personal narrative. These opportunities should come from a variety of topics to ensure that the child can relate to at least one topic. One study by Evans and Craig (1992) compared language sampling techniques in children with specific language impairment (SLI). They analyzed freeplay and interview contexts for developmental sentence analysis, MLU, and advanced syntactic features. Results showed that the interview format resulted in more child utterances, longer sentence lengths, and more advanced semantic features. More simultaneity and greater responsiveness were also seen in the interview format. The interview also seemed to be more reliable in that there was less observed variability. This article concluded that interviews were the most efficient means of conducting language assessments to gather information regarding advanced language skills in children with SLI. Language Sample Analysis Although language sampling has been recommended for use by clinicians for many years, the analysis process was time-consuming and difficult (Kemp & Klee, 1997). To remedy this problem, the Systematic Analysis of Language Transcripts (SALT) computer software was designed in 1985 to analyze language from one or more speakers for morphologic, syntactic, semantic and pragmatic elements. Standard English orthography is used to transcribe utterances into the program in order to analyze the sample for information specified by the examiner. Procedures are based on research by 16 Miller in 1981 from samples taken by a variety of children (Weston, Shriberg & Miller, 1989). SALT has become a commonly used tool for both research and clinical transcript analyses. The specific areas of analysis that can be obtained from the SALT software are varied but the major areas typically investigated are described below. Syntax and Morphology Syntax and morphology go hand-in-hand in language sample analysis. Sentence length and complexity may be assessed using a count of the mean length of utterance (MLU) in morphemes and words. Brown‟s Stages of morpheme development are a related measure of both syntax and morphology. Since both syntax and morphology are measurements of language form, they will be discussed together. Syntax should be measured through analysis of language samples because standardized tests do not provide specific information on a child‟s syntactic deficits. Children often produce sentence forms correctly even when they do not comprehend them when nonlinguistic cues have been removed (Chapman, 1978; Paul, 2000). This might suggest that standardized tests are needed to assess these skills in a decontextualized format; however, it is rare that communication occurs in a completely decontextualized situation and even normally developing children perform worse on these types of assessments (Paul, 2001). In the majority of communication, children are able to use facial expressions, tone, and gestures of others to figure out the meaning of the spoken message. Assessing syntactic skills in more contextualized contexts, such as through a language sample, provides a more functional measure of their syntactic skills and should be included in a comprehensive assessment. Furthermore, gross errors are not 17 often seen in syntax and may emerge as a simpler, more disorganized and less elaborated form of expressive language than their normal developming peers. Syntactic deficits may be a sign of listening and reading comprehension deficits. Expressive syntax delays can also signal lower than average writing skills (Paul, 2001). Before a child‟s MLU reaches Brown‟s Stage V, it is appropriate to analyze MLU, Brown‟s Stages and simple sentence types and structures. Once a child‟s MLU has reached Brown‟s Stage V three measures are used to analyze syntax: 1) analysis of errors in morphological and syntactic form, 2) use of complex syntax and 3) disruptions (Paul, 2001). All of these elements can be analyzed with SALT. In the present study, the first 2 elements of syntactic measurement were used in analysis. The third element was not used because mazes were not coded . Miller (1981) designed an analysis process called Assigning Structural Stage, in which each of Brown‟s grammatical morphemes are assigned to a stage of typical syntactic development. In order for a morpheme to be considered acquired, Brown states that it must be used correctly in 90% of obligatory contexts. Through this analysis, it is possible to examine stages in which a morpheme emerges compared to when it is established (Paul, 2001). In the present study, these elements were examined through SALT analysis and are presented in tables in Chapter 4. Semantics Lexical diversity is a measure of semantics. More precisely, lexical diversity is the ability to used varied and efficient vocabulary in order to communicate effectively. To measure lexical diversity in this study, number of different words (NDW), number of 18 total words (NTW) and Type-Token Ratio (TTR) were analyzed. NDW and NTW are used to calculate TTR by counting the total number of words in a language sample, separating them into the number of different words, then dividing NDW by NTW to yield TTR (Paul, 2001). A study by Klee in 1992 concluded that NDW and NTW show developmental and diagnostic characteristics. In another study by Watkins, Kelly, Harbers and Hollis (1995), it was revealed that analysis of NDW and NTW differentiate children with normal and impaired language development better than analysis of TTR. These two studies suggest that using NDW and NTW alone may be an efficient measure of lexical diversity. The present study includes data for NDW, NTW and TTR in order to provide a more comprehensive picture of the child‟s abilities and the language sampling context‟s effectiveness. Table 2 provides some normative information for NDW, NTW, and TTR in children. Table 2. Normal Range of NDW and NTW in 100-Utterance Speech Samples of Children Between 511 Years (Paul, 2001, p.422). Age NTW NDW 1 SD- 1 SD+ 1 SD- 1 SD+ 5 year olds 156 206 439 602 7 year olds 173 212 457 622 9 year olds 183 235 496 687 11 year olds 191 267 518 868 19 Pragmatics Pragmatic assessment examines the use of language including rules for carrying out successful communication. Successful communication can be assessed through conversational discourse, a measure of one‟s ability to take turns, maintain and change topics, and manage conversational breakdown (Paul, 2001). Assessing pragmatics in children who are hearing impaired is important because “some aspects of narrative skills appear to be impaired” due to pragmatic deficits (Yoshinaga-Itano & Snyder, 1985). In the present study, conversational discourse was measured through turn-taking. It was analyzed by breaking the sample into T-units. A T-unit is classified as “one main clause with all the subordinate clauses and nonclausal phrases attached to or embedded in it” (Paul, 2001, pg. 426). A ratio of subject T-units and examiner T-units was taken in order to examine turn taking and conversation dominance by either the subject or examiner. Other aspects of conversational discourse were not measured in this study. Narrative Development of Children with Hearing Impairment Narrative skills allow children to understand text by understanding story grammar and building a foundation for cohesive text development and reading comprehension. Story grammar focuses on the elements of stories including setting, initiating events, internal responses, attempts, consequences, and reactions which are woven into episodes (Mandler and Johnson, 1977; Peterson and McCabe, 1983; Stein and Glenn, 1982). Cohesion may be defined as “linguistic markers that bind sentences together to make them an integrated discourse unit rather than a series of unrelated utterances” (Paul, 2001). Children‟s beginning understanding of story grammar and cohesive devices will 20 assist them in listening comprehension when books are read to them. Later in the course of literacy development, these aspects of narrative development will assist the child in writing narratives as well as reading them in an appropriate way (Paul, 2001). It is believed that children with hearing impairment develop language and narrative skills in a similar sequence of that of typically developing children. This sequence is commonly delayed and mastered at a slower rate (American Speech Language Hearing Association, 1987). Some different types of narratives include the following: 1.) Personal narratives are those that involve a probe that asks the child to tell a story about something that has happened in their life. This narrative type may be prompted by statements such as “has anything like this ever happened to you? Tell me about it.” and “Can you tell me a time when silly things happened in your kitchen” (Evans & Craig, 1993). 2.) Script narratives require students to relate a routine series of events such as going to the movies or their typical school day (Paul, 2001). 3.) Fictional narratives are those that involve a probe that asks the child to tell a story or describe a plot. These plots can come from a t.v. show or movie. Another approach would be a probe that asks the child to respond to a story generated by the examiner with a retell of that story or to form their own story (Westerveld & Gillon, 2002). A holistic scoring approach to narrative analysis is often used to examine narratives in each of the contexts tested in this study. “The holistic approach takes into 21 consideration the sum of quantifiable elements of the story such as grammar, vocabulary and episodic organization as well as less quantifiable elements like charm, interest and clarity” (McFadden & Gillam, 1996, p. 48). It has been studied by many researchers including Myers (1981), Diedrich (1974), Daiute & Dalton (1988) and Gillam, McFadden and van Kleeck (1995) and found to be an effective form of analysis. McFadden and Gilliam (1996) used a holistic approach to assess written narratives. The narratives were separated into four categories: weak, adequate, good and strong. Figure 3 organizes these stages in more depth. As a result of this review of the literature, and a clear need for clinicians to sample language as effectively as possible with children who are hearing impaired, the current study was developed to answer the following research question: Is there a single method for obtaining a language sample from children with hearing impairment who use oral language as their primary form of communication to get the best representation of actual language skills? Category 1: WEAK- simple descriptions, poor organization and little audience interest Category 2: ADEQUATE- 4 subcategories 1) event recount without a climax 2) bare-bones narrative without elaboration 3) narrative without a clear ending 4) confusing narrative with strong descriptive segments. Category 3: GOOD- appealing narrative, contains problems and resolutions, organizational problems Category 4: STRONG- easily understood, clear and integrated story lines, elaboration, interesting word choices, captivating features including climax, ending twist, or compelling personal voice. Figure 3. Adaptation of McFadden's Holistic Narrative Classification System (1997). 22 CHAPTER 3 METHODS Participants Nine participants were selected for this study from the population of 5;00 to 10;00 year old children with cochlear implants and hearing aids who are enrolled in the University of Tennessee‟s Department of Audiology and Speech Pathology Child Hearing Services (CHS) program. Aside from hearing impairment, these children did not show any indication of other sensory, physical, or neurological problems. All of the participants used spoken language as their primary form of communication. All children were Caucasian and came from families where English was the first and primary language used in the household. Detailed information of subject hearing background can be found in Table 3. The children were recruited as potential subjects through notification of speech language pathologists and/or audiologists in the CHS program. These professionals were given an invitation letter from the investigator to distribute to the parents of prospective participants (See Appendix A). Educators distributed the invitation letter in a sealed envelope directly to the parents. In the invitation letter, the parents were asked to complete an interest form, including their phone number and a convenient time to call, and return it to the investigator in an envelope. The investigator then called the parents directly to provide more information about the study. During the call, opportunities for questions and discussion were provided. 23 Table 3. Subject Hearing Background. Subject Gender Age Age of Identification 1 female 8:5 6 years 2 female 7:4 2 years 3 female 6:6 2 years 5 male 5:2 3 years 6 male 7:10 Degree and Type of Loss Right ear: slight to severe loss Left ear: mild to moderatelysevere sensorineural loss bilateral profound sensorineural loss bilateral profound sensorineural loss bilateral moderate to severe sensorineural hearing loss Age of Initial Aiding Type of Aid Therapy Onset Current type of Aiding Implant Date 6 years bilateral BTE hearing aids 6 years bilateral BTE hearing aids N/A 2 years right ear cochlear implant 2 years right ear cochlear implant 2;8 years 2002 2 years bilateral BTE aids initially 2 years right ear cochlear implant 3 years right ear 2004 3 years bilateral BTE aids 3 years bilateral BTE aids N/A 3 years right ear cochlear implant 3 years right ear cochlear implant 3 years 2003 9 months bilateral cochlear implants 14 months Right ear 2002; 4 years Left ear 2005 7 months bilateral BTE hearing aids N/A 6 months right ear cochlear implant 2 years right ear 2002 6 years bilateral BTE hearing aids N/A 3 years bilateral severeprofound sensorineural loss 9 months 7 female 6:10 9 months bilateral profound sensorineural loss 8 male 7:5 7 months bilateral mild to moderate-severe sensorineural loss 10 months 3 months 5 years 9 female 7:4 birth bilateral severe to profound sensorineural loss 10 male 8:11 3 years bilateral mild to severe sensorineural hearing loss bilateral BTE hearing aids initially bilateral BTE hearing aids bilateral BTE hearing aids initially bilateral BTE hearing aids 24 Materials An Olympus battery operated (VN-480PC) digital recorder was used to record audio samples and a Panasonic (NV-GS120) digital video camera with attached microphone and 700x digital zoom was used to record video samples. Both were used for all subjects. Procedures This study was concerned with identifying a method for obtaining the best possible language sample in elementary school-aged children with varying levels of hearing impairment. The language sampling sessions took place in a quiet room in the University of Tennessee Child Hearing Services program. At the time of the initial assessment, the principal investigator of this study explained the purpose, methods, and procedures of the study to the parents of the participants. Any questions were answered at that time. Each parent of a participant was given a consent form (see Appendix B) to read and sign before the assessment began. The investigator was responsible for obtaining consent forms from all parents of the participants and provided each parent with a copy of the consent form for their own files. All children seven and older signed an assent form (see Appendix C). This form was read aloud to the child before they signed the form. The subject‟s guardian and the examiner‟s supervisor were allowed to be present if they choose or if the subject requested their presence. All participants completed a warm-up activity and three language samples of 10 minutes each taken during a single session of approximately one hour. The three different sampling conditions were presented in random, balanced order. Each session 25 began with a warm-up modeled after the Language Sampling Protocol by Westerveld and Gillon (2002). Following the warm-up, eliciting the first of the three sampling conditions was begun. The three sampling conditions were: (1) a child-clinician interview, (2) a picture description task, and (3) a story with manipulatives. The presentation of the sampling conditions was rotated in 1,2,3 order, with the first child starting the testing with the child-clinician interview, the second starting with picture description task, etc. Each sample elicited general language use as well as the opportunity to formulate a narrative. The aim of each sample was to elicit 50 complete, intelligible utterances within 10 minutes of beginning each sample. Providing visual support generally makes fictional narrative tasks easier. Westby (1989) advocated having hearing students provide the narration for a wordless picture book. Since each of the conditions contained a narrative task within the sample, all conditions were present with visual supports assuming that if hearing children did better with visual stimuli, hearing impaired children would also produce better samples with visual stimuli. Condition I- Interview The child-clinician interview was modeled on an interview protocol used by Evans and Craig (1992). The narrative sample obtained in this condition included discourse about a recent holiday and other events related to pictures shown (photographs of principal investigators family, various holidays, and animals) used to elicit language (See Appendix E for script). 26 Condition II- Picture Description “The Kitchen” picture (Amery, no date) was used for language elicitation in the picture description task. The subject was asked to talk about objects in the picture and describe what was happening. The subject was also asked to relate events in the picture to their own life in story form (See Appendix F for script). Condition III- Story Retell with Manipulatives A book created by the principal investigator was used to elicit language for story retell. It was a felt story book that contained all elements of story grammar that make up a complete narrative (see Figure 4). The principal investigator told each child the story, showing the child how to move the characters in the book. The book allowed the child to move characters to follow along and create a story after the initial story had been presented (See Appendix G for script). In this condition, the narrative was the focus of the sample. Story= Setting + episode structure Episode= Initiating event + internal response + plan + attempt + consequence + reaction Setting – introduces the main characters, the protagonist, and the context of time and place. Initiating event- the occurrence that influences the main character to action. It may be a natural event, an action, or an internal event, such as a thought, perception or wish. Internal response- indicates the thoughts and feelings of the main character in response to the initiating event. It may include an interpretation of the event, formulation of a goal, or some other response. Plan- indicates the intended action of the main character. Attempt- indicates the actions of the main character in pursuit of the goal Figure 4. Taken from Paul (2001) Box 11-1 Story Grammar (p. 392). 27 Data Analysis Data were analyzed using the Systematic Analysis of Language Transcripts (SALT) Software Student Edition (2006) for narrative structure, vocabulary, syntax and morphology. The SALT program is a computerized program that analyzes samples for the language features of interest including: total number of utterances, mean length of utterance, type-token ratio (a measure of vocabulary), total number of words, and total number of morphemes. The subject‟s utterances were separated into T-units for conversational analyses. In addition to language analysis, narrative analysis was also evaluated using McFadden‟s (1996) categories for holistic analysis of narratives. 28 CHAPTER 4 RESULTS In order to determine which of the three language sampling methods provided the most comprehensive information within a ten minute sample, within and between subject analyses were performed. The following language skills were assessed using SALT: greatest number of utterances, greatest MLU in words and morphemes, greatest TTR, highest Brown‟s morpheme developmental stage, greatest variety of sentence types, and greatest variety of word frequency types. It is important to note that all subjects did not reach the ten minute limit for each elicitation context. Each subject was given the opportunity to take as long as necessary on each task. Some subjects took more than the allotted ten minutes while others terminated the task early. Testing was discontinued when the child said “I‟m done” or refused to continue. Table 4 presents timing data in minutes: seconds (mm:ss) form. Subject samples which surpassed the ten minute limit were cut at the ten minute mark and only the data within the ten minute block were used for analysis. The exception to this was the analysis conducted on narrative structure. Narratives were taken from the samples according to the “best” representation of narrative skills according to the examiner regardless of the corresponding time. Table 5 gives time averages for each elicitation context. Table 6 shows number of subject utterances in T-Units within the 10 minute limit for each subject. All subjects surpassed the 50 utterance goal for the interview context. 29 Table 4. Total Elicitation Time for Each Context By Subject. Subject Number Interview Picture Description Story Retell 1 08:29* 04:16 05:49 2 08:45 07:46 10:00* (10:40) 3 08:00 08:22 10:00* (14:40) 5 10:00 (12:50) 05:48 10:00* (15:36) 6 10:00* (11:52) 07:12 07:26 7 10:00 (11:55) 10:00 (10:56) 10:00* (12:50) 8 08:40* 08:01 08:10 9 06:40 05:56 08:11* 10 07:35 10:00* (15:15) 09:00 Time in ( ) = total time of sample if more than 10 minutes.*= longest sample time by context within subjects Table 5. Average Times for Each Elicitation Technique. Interview Picture Description Story Retell Average time with 10 minute restrictions (used in analysis) 8:41 7:29 8:44 Average time without 10 minute restrictions 9:25 8:10 10:15 30 Table 6. Number of Subject Utterances (in T-Units) by Context within 10 Minutes. Interview 1 2 3 5 6 7 8 9 10 75 77 101 91 101 107 118 60 65 35 86 81 63 67 95 102 45 100 36 70 110 31 27 80 56 42 45 Picture Description Story Retell Some subjects did not reach the 50 utterance goal for the picture description context (two subjects) and the story retell context (five subjects). The subjects who did not reach 50 utterances during picture description (subject 1 and subject 9) had short total elicitation times giving less opportunity for utterance production. The subjects who did not reach 50 utterances in story retell showed one of two patterns: either the subject did not have a total sample time reaching 10 minutes or the subjects total elicitation time was over the 10 minute limit, but the majority of the sample was made up of examiner utterances. This was necessary in order for the examiner to present the story. Within Subject Analysis Syntax and Morphology – Mean Length of Utterance Language samples from each of the conditions were analyzed for length of utterance in words and morphemes. Table 7 presents these data for each participant by sampling condition. 31 Table 7. Within Subject Analysis MLU in Words and Morphemes. Subject Interview Picture Description Story Retell Words Morphemes Words Morphemes Words Morphemes 1 3.38 4.21 3.94 4.6 4.83* 5.33* 2 2.19 2.40 3.09 3.34 3.77* 4.16* 3 1.98 2.06 1.88 2.00 2.17* 2.82* 5 4.08 4.30 4.25 5.62* 4.58* 4.81 6 2.65* 2.73* 2.66 2.76 2.59 2.70 7 3.91 4.24 4.61 5.25 5.42* 6.03* 8 4.30 4.60 4.99 5.53 5.41* 5.80* 9 3.67 4.05 4.39* 5.08* 4.25 4.60 10 5.31* 5.75* 5.18 5.69 4.64 4.96 * = Context with highest MLU for words and morphemes within subjects Syntax and Morphology – Morpheme Development For four subjects, the highest Brown‟s stage of morpheme development was elicited by picture description and story retell. For three subjects; all three contexts yielded the same stage. Story retell either provided the top score or tied for the top score for all subjects. Table 8 provides information on the level of morpheme development for each child, under each condition. Bound morphemes were examined as an element of Brown‟s morpheme development. Bound morpheme analysis gives a more detailed picture of the subjects‟ deficits in this area by examining specific morphemes rather than the stage as a whole. Bound morpheme omission by elicitation context can be seen in Table 9. Within subject 32 analysis shows that the story retell context elicited the fewest bound morpheme errors (shown by greatest number of errors in one subject) followed by the interview context (greatest number of errors in 3 subjects) and finally with the picture description context (greatest number of errors in four subjects) Syntax and Morphology – Utterance Level Errors Analysis of utterance level error is an examination of syntax. Utterance level errors are those involving sentence formulation and word ordering (SALT, 2006). In the present study, the majority of the subjects presented with the most utterance level errors in the interview context. Results can be seen in Table 10. Table 8 Within Subject Analysis of Brown's Stages of Morpheme Development. Subject Interview Picture Description Story Retell 1 Late V Post V* Post V* 2 II Early IV Late V* 3 II II III* 5 Late V Post V* Post V* 6 III* III* III* 7 Late V Post V* Post V* 8 Post V* Post V* Post V* 9 Late V Post V* Post V* 10 Post V* Post V* Post V* 33 Table 9 Number of Bound Morphemes in Error According to Sampling Condition Subject Interview Picture Description Story Retell 1 0 4* 1 2 3 15 21* 3 20* 2 10 5 7* 7* 4 6 18* 6 5 7 0 0 0 8 4 5* 2 9 0 0 0 10 5 7* 4 *= Context with highest Brown‟s morpheme stage within subjects Table 10. Within Subject Analysis: Utterance Level Errors. Subject Interview Picture Description Story Retell 1 3 0 2 2 2 16* 16* 3 10* 2 4 5 24* 8 2 6 10* 10* 2 7 5* 4 5* 8 3* 1 1 9 1 3 4* 10 1 12* 3 *= greater number of errors by context for each subject 34 Semantics – Type-Token Ratio The language samples were evaluated for the number of different words (NDW), the number of total words (NTW), and the type-token ratio (TTR). The TTR score is derived from NDW and NTW scores. Type-token ratio is a measure of lexical diversity and gives a picture of a child‟s ability to use their vocabulary. No single context elicited the highest NDW, NTW, or TTR (See Table 11). Semantics – Frequency of Word Errors Frequency of word errors and omissions was examined in order to investigate the subjects‟ broad picture of overall vocabulary mastery. Irregular verbs and pronoun usage were common word errors with the most frequently omitted words being function words (a, and, the, etc.). Contexts that elicited the most word errors and omissions were the interview context and story retell context. Picture description showed the fewest instances of errors and omissions at the word level. Table 12 shows the results. Pragmatics The literature on early language development indicates that children with appropriate pragmatic skills are better able to utilize turn-taking behavior, comprehend social situations, emotions, and figurative language in reading and use these pragmatic aspects in forming narratives (Paul, 2001). This study measured turn-taking behavior as a measure of pragmatics by determining the ratio of each child‟s utterances to those of the examiner. Again, no single condition prompted the most balanced turn-taking ratio with four subjects scoring highest in the interview context, 3 subjects scoring highest in 35 Table 11. Within Subject Analysis: NDW, NTW, and TTR. Subject Interview Picture Description Story Retell NDW NTW TTR NDW NTW TTR NDW NTW TTR 1 128 287 .45 78 138 .57* 72 174 .41 2 86 169 .51* 106 266 .41 107 264 .41 3 71 200 .35 72 152 .47* 72 239 .30 5 117 371 .32 91 268 .34 73 142 .51* 6 105 268 .39 81 178 .46 46 70 .66* 7 184 418 .44* 170 438 .39 144 434 .33 8 174 507 .34 172 509 .34 144 303 .48* 9 99 220 .45 91 167 .54* 74 170 .44 10 140 313 .45 194 518 .37 105 209 .50* *= Context with highest TTR within subjects 36 Table 12 Within Subject Analysis: Frequency of Word Error and Word Omissions By Elicitation Context Subject Interview Picture Description Story Retell Omissions Errors Omissions Errors Omissions Errors 1 1* 3* 0 2 1* 2 2 9 1 13 13 23* 15* 3 16 10* 1 1 24* 2 5 7* 22* 1 6 3 1 6 20* 6 18 10* 4 2 7 1* 4 0 4 0 7* 8 6* 4* 2 0 0 0 9 1 1 0 0 2* 4* 10 3 1 6* 12* 3 3 *= greatest number of word errors or omissions for each context by subject the picture description context, and 2 subjects scoring highest in the story retell context These results can be seen in Table 13. Narrative Analysis Using a system described by McFadden and Gillam (1996), narrative ability was scored on a 1-4 scale from Weak to Strong. Their research suggests that longer stories, such as those produced in the story retell context, tend to receive higher marks of quality. The current study confirms this as the story retell context produced the most advanced narratives for the majority of subjects (Refer to Appendix J). Table 14 shows the results. 37 Table 13. Within Subject Analysis: Ratio of Child (C) and Examiner (E) Total Utterances in TUnits. Subject Interview Picture Description Story Retell C E Ratio C E Ratio C E Ratio 1 75 122 1:1.62* 35 61 1:1.74 36 71 1:1.97 2 77 158 1:2.05 86 79 1.08:1* 70 97 1:1.38 3 101 145 1:1.43 81 118 1:1.45 110 138 1:1.25* 5 91 101 1:1.10* 63 82 1:1.30 31 92 1:2.96 6 101 146 1:1.44* 67 117 1:1.74 27 104 1:3.85 7 107 112 1:1.04 95 66 1.43:1 80 83 1:1.03* 8 118 115 1.02:1* 102 72 1.41:1 56 82 1:1.46 9 60 111 1:1.85 45 75 1:1.66* 42 94 1:2.23 10 64 95 1:1.46 100 80 1.25:1* 45 87 1:1.93 *= Context with ratio closest to 1:1 within subjects 38 Table 14. Within Subject Analysis: Narrative Ranking Subject Interview Picture Description Story Retell Narrative Average 1 2 (Adequate, subcategory 2) 1 (Weak) 2.5 better than 2 (Adequate, subcategory 2), not quite 3 (Good) 1.83 Adequate 2 1 (Weak) 1.5 better than 1 (Weak) not quite 2 (Adequate, subcategory 4) 3 (Good) 1.83 Adequate 3 0 none present 1 (Weak) 1.5 better than 1(Weak) not quite 2 (Adequate subcategory 1) .83 Weak 2 (Adequate subcategory 3) 2 (Adequate subcategory 4) 2 Adequate 1 (Weak) 2 (Adequate subcategory 1) 1.8 Adequate 3 (Good) 3.5 better than 3 (Good) not quite 4 (Strong) 2.83 Good 8 2 (Adequate, subcategory 1) 2.5 better than 2 (Adequate subcategory 4) not quite 3 (Good) 4 (Strong) 2.83 Good 9 2 (Adequate, subcategory 1) 2 (Adequate subcategory 1) 10 3 (Good) 2 (Adequate subcategory 4) 5 6 7 2 (Adequate, subcategory 1) 2.5 better than 2 (Adequate, subcategory 2) not quite 3 2 (Adequate, subcategory 2) 2.5 better than 2 (Adequate subcategory 2) not quite 3 (Good) 3 (Good) 2.16 Adequate 2.66 Good 39 Between Subject Analysis Syntax and Morphology Across all subjects, the greatest number of utterances was elicited in the interview context. The greatest MLU in words and morphemes were elicited in the story retell context. TTR was evenly distributed with three subjects scoring highest in each of the elicitation conditions. The most advanced Brown‟s morpheme development stage was elicited through story retell followed by picture description. Sentence types were analyzed to find which context would yield the highest frequency for each sentence type. The elicitation technique that yielded the highest frequency for each sentence type, per subject, was highlighted and counted as 1 (i.e. each subject would have a total of 1 elicitation type for each sentence type). A between subject analysis was then completed by counting each context that received a 1 to determine which elicitation contexts consistently produced the greatest number of sentence types. Results showed that the greatest number of sentence types was elicited in the interview context with the breakdown as follows: statements, questions, and responses to questions. The one exception was seen in exclamations where picture Table 15. Between Subject Analysis: Total Sentence Type by Greatest Frequency. Sentence Type Statements Exclamations Questions Responses to Questions Interview 4* 1 8* Picture Description 3 4* 0 Story Retell 2 4* 1 6* 3 0 *= Context eliciting sentence type most frequently between subjects 40 Table 16. Between Subject Analysis: Average Number of Omitted Bound Morphemes by Elicitation Context. Average Number of Omissions Interview Picture Description Story Retell 6.3 5.1 5.2 description and story retell both elicited the greatest frequency of this sentence type. These results can be viewed in Table 15. When examining omitted bound morphemes for all subjects, the highest number of omissions occurred in the interview context (See Table 16). Semantics Average TTR between subjects can be seen in Table 17. Overall, story retell elicited the greatest TTR averaging .44, but all contexts fell very close with picture description averaging .43 and interview averaging .41. Small differences in TTR scores are more significant due to the ratio they are measuring. Since TTR is a measure of vocabulary richness, these results lead to the assumption that story retell produced more vocabulary-rich language. Semantic development was assessed by determining the greatest number of word frequency types is shown in Table 18. Overall, interview and picture description yielded the highest count or equal to the highest count for six of the 14 different sentence types. Overall frequency was determined by analyzing each word type within subjects to find which context yielded the greatest number of the word type in each elicitation context. This context was highlighted and counted as one. A between-subject analysis was then completed by counting each context that received a one to determine the context that 41 Table 17. Between Subject Analysis: Average TTR by Elicitation Context Average TTR Interview Picture Description Story Retell .41 .43 .44* *= greatest TTR by context Table 18 Between Subject Analysis: Total Word Type by Greatest Frequency. Word Type Question Words Negatives Conjunctions Modal Auxiliary Verbs Personal Pronouns Possessive Pronouns/Determiners Reflexive Pronouns Demonstrative Pronouns/Determiners Relative Pronouns in Utterances not ending in „?‟ Universal Pronouns/Determiners Partitive Pronouns/Determiners Quantifying Pronouns/Determiners Yes/No Words Filled Pause Words Interview 8* 6* 1 3 7* Picture Description 0 4 5* 4* 1 Story Retell 1 0 4 0 1 4* 4* 2 0 1* 0 4 5* 0 2* 0 2* 4* 4* 1 1 6* 3 6* 4 0 7 4* 9* 3 0 0 *= Greatest number elicited by context between subjects 42 elicited the most of the word type category between subjects. When examining word error and omission frequency, it was found that the interview context elicited the most errors and omissions. Although the interview context had the highest total number of errors and omissions, the interview and story retell contexts had the highest number of errors within-subjects (See Table 19). Pragmatics Across subjects, pragmatics was assessed through turn-taking. The picture description condition yielded the child: examiner turn-taking ratio closest to 1:1, indicating a balance of time verbalizing. Results can be seen in Table 21. Table 19. Between Subject Analysis: Average Number of Word Error and Word Omission Frequency by Context. Average Number of Word Errors Average Number of Word Omissions Interview Picture Description Story Retell 5.7 5.3 4.0 7.1 4.5 6.6 Table 20. Between Subject Analysis: Average Number of Utterance Level Errors by Context Average Errors Interview Picture Description Story Retell 6.5 6.2 4.3 43 Table 21. Between Subject Analysis: Pragmatic Skills as Measured by Turn-Taking Measure Interview Picture Description Story Retell Child (C) 88.2 74.8 55.2 Examiner (E) 122.7 85.5 94.2 Ratio (C:E) 1:1.4 *1:1.1 1:1.7 *= ratio closest to 1:1 Narrative Analysis The ability to produce a narrative was evaluated across the three elicitation conditions for all subjects. The result showed that the story retell context produced the most advanced narrative averaging 2.66 on the McFadden and Gillam (1996) scale indicating that the average narrative produced by the subjects was ranked as “good”. Table 22 shows the results for each child by sampling condition. 44 Table 22. Between Subject Narrative Analysis: Comparison by Number of Subjects per Ranking Score 1 Weak 1.5 Weak/Adequate 2 Adequate 2.5 Adequate/Good 3 Good 3.5 Good/Strong 4 Strong Average Score Interview Picture Description Story Retell 1 3 0 1 1 1 5 3 2 0 1 2 1 0 2 0 1 1 0 0 1 1.72 (Adequate) 1.83 (Adequate) 2.66* (Good) *= context eliciting highest narrative generation skills 45 CHAPTER 5 DISCUSSION AND CONCLUSION The goal of this study was to determine if there was an optimal language sampling context for children with hearing impairment. Specifically, the investigator wanted to see if any well-documented method of obtaining a language sample was superior to the others in describing the areas of language that are known to serve as a foundation for later literacy development. Results of this study were analyzed in categories known to be critical to early literacy development as described in models of literacy acquisition by Adams (1990) and van Kleeck (2007). Syntax and Morphology Syntax and morphology were evaluated by analyzing the mean length of utterance (MLU) in words and morphemes, Brown‟s Stages of morpheme development, bound morpheme errors and utterance level errors. The results of MLU analyses across the three elicitation contexts were inconsistent. It is hypothesized that this difference is due to the subject‟s interest in the activity. In activities that appeared to be exciting to the subject, MLU was higher. In all probability, this was because they were more engaged and vocal. One consideration concerning MLU is that it may be higher in the story retell context due to the large number of sentence models given by the examiner during the initial story. Although the subjects were allowed to make up their own stories or use the story told by the examiner, most of the subjects‟ stories resembled the initial story thereby using the examiner‟s sentence models. Brown‟s Stage analysis revealed that the story retell context resulted in the most 46 advanced stage for all of the subjects. Again, this may be attributed to the fact that the examiner provided many examples of advanced syntax models in the initial presentation of the story. However, research shows that children who do not have syntactic features in their spontaneous repertoire, will not produce them in a story retell task after having been given a model (Maxwell, 1997). It may be that story retell was simply the more challenging and engaging condition or it may be that this context prompted the children to work at or near the best of their abilities. Bound morpheme errors and utterance level errors are a broad representation of overall syntax development. Results showed most occurrences of errors in both bound morphemes and utterance level structure were revealed in the interview context. The possible reasons for this are unclear. However, according to a study by Evans & Craig, (1992) the interview context was superior to free play in eliciting more complex syntax and semantics. It may be that the interview context provides a context that results in a “dense” sample and this explains the greater number of errors. In this case, the interview context may be useful in showing where the child starts to breakdown and where treatment needs to start in order to help them achieve age-appropriate language. Semantics Hearing impaired children often have reduced vocabularies compared to hearing children (Elfenbein et al., 1994) and is a critical area for analysis. The area of semantics was evaluated through the analysis of number of different words (NDW), number of total words (NTW), type-token ratio (TTR), errors at the word level, and word type frequencies between contexts. Within subjects, TTR scores (the ratio of NDW/NTW) 47 were evenly distributed with three subjects scoring their highest TTR in the interview context, three in the picture description context and three in the story retell context. When TTR was averaged for overall scores in each context, story retell produced the highest TTR. This leads to the possible conclusion that vocabulary richness may best be measured with story retell, a narrative-based assessment. These findings suggest that language samples should include a story retell opportunity. It was found that word level errors could be seen in all elicitation contexts; however, they were most frequent in the interview context. Again, like the results seen in the analyses of word level errors, the interview context may provide the opportunity for obtaining the most syntactically and semantically complex information. Pragmatics Pragmatic skills were evaluated using a measure of turn-taking. Turn taking is a component of speech that dictates conversational rules. By using appropriate turn-taking skills one is showing understanding of rules for encoding meaning in speech and will later be used in rules for conveying meaning in writing and reading ( Dudley-Marling & Rhodes, 1987; Cooper, 1982). Turn-taking was measured by taking the ratio of T-units spoken by the subject and examiner for each language sample context with the goal of reaching a 1:1 ratio. Picture Description yielded the closest ratio when averaged across subjects reaching a 1:1.1 ratio (subject: examiner). It was not expected that story retell would receive a 1:1 ratio due to the monologue nature of narratives. It is important to note that all contexts averaged ratios near the 1:1 goal. While turn-taking is not a direct measure of preliteracy skills, it does show the subjects ability to participate in dialogue; 48 which is important for later literacy development (Dudley-Marling & Rhodes, 1987). Narrative Development Narrative development was a vital area for assessment in this study. Problems in narrative skills indicate that a child is at-risk for both literacy and social development (Bishop & Edumndson, 1987; Feagans & Appelbaum, 1986; Feagans & Short, 1984; Hemphill & Siperstein, 1990). Narrative development was assessed following the guidelines given by McFadden and Gillam (1996) and was used for both personal (found in interview and story retell) and story retelling narratives (found in the story retell context). Conclusions Through the analysis of this study, it has been determined that in order to get a comprehensive view of language in hearing impaired children who use oral language as their primary communication, one single method of language sampling may be insufficient. The language sample contexts used in this study followed the guidelines set by Westerveld and Gillon (2002) that recommend “assessing conversational language as well as two measures of narrative ability: personal narratives and story retelling” (p. 8). An advantage in this study‟s protocol is that both conversation and narratives were measured across multiple sampling contexts while the Westerveld and Gillon protocol separated each target into separate sampling contexts. By assessing conversational language, personal narratives and story retelling in more than one context, it may give the examiner a better view of the child‟s actual language skills. This is an 49 important consideration for children with hearing impairment. This study‟s results were concurrent with Westerveld and Gillon (2002) in the respect that each context showed variation in the child‟s language skills. In the present study, the interview context provided the most total utterances within a ten-minute limit. The story retell with manipulatives provided the highest MLU in the study‟s subjects. Overall, each of the assessments gave varying degrees of insight into language elements that contribute to literacy development. These elements include vocabulary richness, sentence formulation, narrative development and pragmatic skills. It remains unpredictable which activities will stimulate the most comprehensive language sample from subjects. Different children respond differently to the sampling contexts and it appears that their level of interest in the activity contributes to their scores on the assessments. Limitations The author recognizes that there were limitations with this study. First, there was only one examiner in the study. This provided the study with good internal reliability, but may have affected the study in that the subjects may have performed differently with different examiners which could influence the outcomes overall. A second limitation was the limited number of subjects used in the study. The required subject characteristics made finding a large sample difficult. Statistical significance could only be obtained if the sample size had been larger;. A third limitation is that the study results cannot be generalized for the total hearing impaired population that uses oral communication as their primary method of 50 communication. All subjects were Caucasian children who used English as their primary language and had been aided before the age of 3 as well as attended the University of Tennessee Department of Audiology and Speech Pathology Child Hearing Services program. Therefore, the results of the study can only be applied to this similar population. It is possible that children participating in other therapy programs, different from CHS, or coming from different ethnic or economic backgrounds would show different results given the same battery of tests due to their exposure to other therapy approaches. Implications for Further Research In the future, the results of this study might be extended through research that examines a larger, more diverse population in order to give a more comprehensive view of this test battery‟s effectiveness for multiple populations. These populations should include children with hearing impairment from multiple therapy programs and schools, varied socioeconomic status, ethnicities, and children from parents who are hearing impaired. To further test the language sampling contexts used in this research, it would be useful to examine a similar battery that does not use visual supports. 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Volta Review, 87 (5), 75-90. 59 APPENDICES 60 Appendix A Parental Informed Consent Form Comparing Language Samples Obtained Under Three Sampling Conditions Information for Parents and Guardians Dear Parents and Guardians: Language development is an important part of future success in a child‟s school and life experience. One method that is frequently used to evaluate language understanding and expression is a language sample. At the present time, there is no research that tells us what type of language sample collection method is best for children with hearing impairment. My interest is in finding out the sampling method that provides the best possible results for children with hearing impairment. My name is Katie Stilwell and I am in my second year of the speech pathology graduate program at The University of Tennessee. I will be focusing my study on children who are between the ages of five and ten years of age who wear hearing aids or cochlear implants and have been aided since or before the age of three. An assessment will take place in one 50 minute session at the University of Tennessee Child Hearing Services. During the 50 minute session, there will be three language sampling methods tested. These will include a picture description task, a story re-tell task, and an interview. All three methods are commonly used and frequently described in research. There should be no discomfort or stress associated with the testing. However, if your child becomes tired, frustrated, or requests a break, testing will be discontinued and, if you desire, rescheduled. Parental or guardian permission is required for your child to participate in the study. Please sign and return the attached form if you will consider your child for participation. When I receive this form, I will call you to discuss the study and set up an appointment for testing. At the time of testing you will be asked to sign a parental permission form. Children who are seven years old or older will be asked to sign an assent form. All test materials including audio and video records that I use will be coded and assigned a number. Your child‟s name will only appear on a key available to my advisor, Dr. Ilsa Schwarz who is Head of the Department of Audiology and Speech Pathology, a speech pathology graduate assistant, who will assist in evaluating accuracy of analysis, and to me. All testing materials will be stored in a locked file cabinet. When the study is complete, the key that contains the students‟ names and personal information will be destroyed in order to ensure confidentiality. Audio and video taping are a required aspect of the study in order to ensure high quality, accurate transcriptions and analysis of the samples collected of your child. The entirety of the session will be taped to guarantee a complete sample. Please consider this when deciding to participate in this study. Please feel free to contact me for further information. I will be happy to answer any 61 questions or concerns you may have regarding the study. You may reach me or my advisor Dr. Ilsa Schwarz, through the Department of Audiology & Speech Pathology at (865) 974-5019. If you have any questions with regard to your child‟s rights as a research subject, you may contact the Office of Research at the University of Tennessee at (865) 974-3466. I look forward to working with your son or daughter. Please retain this letter for your own records. 62 Appendix B Parent/Guardian Interest Form Please sign this form and return it to Child Hearing Services care of Katie Stilwell if you will consider having your daughter/son participate in the study. When the form is received, I will contact you to discuss the study in further detail. (Please print) Name of parent/legal guardian: Signature of parent/legal guardian: Name of daughter/son: School: Phone number: Best time to be reached: Today‟s date: 63 Appendix C Child Assent Form I have been asked to take part in a study about telling stories and talking with a teacher named Katie, who I can talk to or my mom can call at 501-590-6272 or email at [email protected]. The study is being done at the University of Tennessee. For this study, I will be asked to tell stories and talk to the teacher. The teacher and I will be video taped and audio taped while we are talking so that she can use my information in the best way possible. I won't be asked to do anything else for this project. This research will help people learn more about how students my age tell stories and use words. I understand that information about my name and age will be thrown away after my test forms are assigned a code number. I also understand that I may stop the testing at any time if I need to take a break or if I am feeling uncomfortable. If I have any questions about this study, I am free to ask the teacher now or anytime when I am answering the questions. I volunteer to participate in this study. Name: ___________________________________________________ (Please sign using handwriting) Today's Date: _____________________________________________ 64 Appendix D Warm-Up Script: (3-7 minutes timed) Hi! I‟m Katie. What‟s your name? Miss (clinician) told me that you were really smart and a lot of fun. I want to play with you today and talk with you for a little while. I thought we could start by making a card. I‟m going to make a Valentine for (clinician). 65 Appendix E Interview Script: (15 minutes maximum timed) Would you like to see some pictures of my family? This is my Mom and Dad…brother, sister. I am the oldest in my family. I bet you have a family. Tell me about them! Look, here is a picture of my family on a trip or vacation. We went to the beach in the summer. That‟s my favorite place to go. I like pick to up seashells by the water. Have you ever been on a trip? Where did you go? What did you do? Tell me about it. Oh, here‟s a picture of my dog. His name is Bentley. He knows lots of tricks and he loves to play outside. Sometimes he licks me right in the face! Do you have any pets? Tell me about your pets! (if they have no pets say what kind of pet would you like to have? what would you do with your pet?) Guess what my mom has for pets? Chickens! Aren‟t they funny? There are a whole bunch of them. Do you know anything about chickens? What do you know? Do you know anyone who has funny pets? Tell me about them! Here is a picture of my grandparents. I love them very much and they do nice things for me like cook dinner for me and send me letters in the mail. Do you have grandparents? What kind of nice things do they do for you? This is a picture of my cousins. We have the same grandparents but different mommies and daddies. We love to see each other at Christmas time. When we were your age we played outside together a lot! Do you have cousins? When do you see each other? Tell me about the things you do together. Here is a picture of when _____ was little. It‟s a birthday party and _____ is blowing out the candles on the birthday cake. I bet you‟ve had a birthday party before! Tell me about your birthday party. (additional probing questions may be asked as necessary) 66 Appendix F Picture Description Script: I want to show you a funny picture. There are a lot of things happening in this picture and I want you to help me find all of the silly stuff. (take turns pointing a few things out) Do you see the key on the table? Are key‟s supposed to go on the table? Where do they go? Do you see the animals in the kitchen? Can you find them? How many kids are there? (help count if necessary) What‟s silly about these kids? Can you find the mama and the daddy? What are they doing? Which one is in the house? I see a broken plate. Can you find it? What do you think happened? It looks like there are a lot of things going on in this kitchen! Can you tell me a story about what you think is happening? Try to tell me as much as you can about what‟s going on in this picture! Why is that silly/dangerous/etc.? What do you think will happen next? Can you think of a time when that happened at your house? Tell me a story about it! 67 Appendix G Story Retell Lost! Picture 1: One day, Michael the boy decided to take a walk in the forest. He would go exploring, it would be an adventure! Michael waved goodbye to his mother and goodbye to his dog, Sam and he was ready to go. Picture 2: First he came to a fence, He climbed over the fence and into a field of grass Picture 3: Finally, Michael came to the forest. It was full of big trees! He saw a small road called a path. Michael decided to see where the path would take him. He began walking down the path and what did he see? Michael saw footprints. They looked like they were from an animal. What kind of animal? Michael thought. I guess I‟ll have to follow these footprints to find out. Picture 4: Michael followed those footprints. He followed them right to a small animal. The animal looked like a cat. It was black and white. Oh no, that animal was not a cat! It was a skunk! Yuck, that skunk did not smell good! Michael ran down the path as fast as he could! Picture 5: Michael ran and ran until he saw water. The water was a pond. He sat down by the pond so he could see what was in the water. He saw a frog and lots of little fish. Michael began to think of the other things he might see in the pond. He might see bugs, or turtles, or alligators! He did not want to see any alligators! Michael quickly got up from the pond and looked around. Uh Oh! Michael did not know where he was! Michael was very scared! 68 He wanted to go home but he was lost! Picture 6: Michael began running and he heard noises around him. Was it lions? Tigers? Bears? Snakes? This was very bad! The sounds were getting louder and louder, closer and closer. Then, out popped Michael‟s dog, Sam. This made Michael very happy. Those sounds were not dangerous animals! It was only Sam coming to find Michael. Picture 7: Michael and Sam happily walked out of the woods Picture 8: and into the grassy field, jumped over the fence Picture 9: and raced home to tell Michel‟s mom about his adventure in the woods. THE END! Did you like that story? Now, I want you to tell me a story with this book. You can tell the story that I told, or you can tell your own with this book. 69 Appendix H Subject Analysis 70 Subject 1: Analysis Interview Picture Description Story Retell Interview Picture Description Story Retell Subject Total Utterances (Examiner) 75 (122) 35 (61) 36 (71) Conjunctions 23 6 24 MLU in Words 3.83 3.94 4.83 Modal Auxiliary Verbs 0 2 1 MLU in Morphemes 4.21 4.6 5.33 Semi-Auxiliary Elements 0 0 0 TTR 0.45 0.57 0.41 Personal Pronouns 37 19 27 NTW 287 138 174 Possesssive Pronouns & Determiners 0 1 1 NDW 128 78 72 Reflexive Pronouns 0 0 0 Statements 69 (92%) 32 (91.43%) 28 (77.78%) Demonstrative Pronouns & Determiners 4 5 1 Exclamations 2 (2.67%) 0 0 Relative Pronouns in Utterances not ending in '?' 0 0 2 Questions 1 (1.33%) 1 (2.86%) 6 (16.67%) Universal Pronouns & Determiners 1 6 2 Responses to Questions 34 (45.33%) 19 (54.29%) 2 (5.56%) Partitive Pronouns & Determiners 0 2 1 Brown's Stage Late V Post V Post V Quantifying Pronouns & Determiners 2 1 0 Yes and No Words Filled Pause Words 11 1 3 0 0 0 Word Types Question Words Negatives 1 8 1 4 6 3 71 Subject 1: Profile Analysis Interview Compared to Normative Sample 1 Sample Picture Description Compared to Normative Sample Total Utterances 75* 151.19 Total Utterances NTW 302* 1067.78 MLU in Words 3.83* MLU in Morphemes Sample Story Retell Compared to Normative Sample 1 Sample 35 35 Total Utterances 36 46.74 NTW 143* 254.59 NTW 174 420.57 6.35 MLU in Words 3.94* 6.54 MLU in Words 4.83** 7.85 4.21* 7.02 MLU in Morphemes 4.60* 7.26 MLU in Morphemes 5.33** 8.59 TTR .45** 0.31 TTR .57** 0.47 TTR 0.41 0.43 Question Words 1 1.15 Question Words 1 0.11 Question Words 2 0.76 Negatives 8 15.7 Negatives 4 3.04 Negatives 3 4.89 Conjunctions 23* 103.7 Conjunctions 6* 25.41 Conjunctions 24 41.89 Modal Auxiliary Verbs 0* 7.37 Modal Auxiliary Verbs 2 1.74 Modal Auxiliary Verbs 1 3.04 Personal Pronouns 37* 137.19 Personal Pronouns 19* 31.52 Personal Pronouns 27 44.72 0 4* 3 8 0.7 15 4.96 7.46 Bound Morphemes Bound Morphemes /es /ed /ing /s 1 0* 1* 5 7* /es 10.7 1 3.04 /ed 8.7 1 1.89 /ing 12.22 13** 3.44 /s 31.26 1* 8.44 * one devation from the mean, ** two deviations from the mean Bound Morphemes /es /ed /ing /s 72 Subject 2: Analysis Interview Picture Description Story Retell Interview Picture Description Story Retell Subject Total Utterances (Examiner) 77 (158) 86 (79) 70 (97) Conjunctions 9 33 22 MLU in Words 2.19 3.09 3.77 Modal Auxiliary Verbs 2 0 0 MLU in Morphemes 2.4 3.34 4.16 Semi-Auxiliary Elements 0 0 0 TTR 0.51 0.41 0.41 Personal Pronouns 21 29 41 NTW 169 266 264 Possesssive Pronouns & Determiners 7 8 3 NDW 86 108 107 Reflexive Pronouns 0 0 0 Statements 60 (77.92%) 74 (86.05%) 60 (85.71%) Demonstrative Pronouns & Determiners 6 11 8 Exclamations 2 (2.6%) 1 (1.16%) 2 (2.86%) Relative Pronouns in Utterances not ending in '?' 0 0 0 Questions 15 (19.48%) 8 (9.30%) 7 (10.00%) Universal Pronouns & Determiners 8 0 2 Responses to Questions 39 (50.65%) 28 (32.56%) 6 (8.57%) Partitive Pronouns & Determiners 0 1 1 Brown's Stage II Early IV Late V Quantifying Pronouns & Determiners 4 4 2 Yes and No Words 3 6 3 Filled Pause Words 0 0 0 Word Type Frequency Question Words 4 (15) 2 (8) 1 (7) Negatives 3 2 2 73 Subject 2: Profile Analysis Interview Compared to Normative Sample 2 Sample Picture Description Compared to Normative Sample Total Utterances 77 142.93 Total Utterances 7.33 7.23 NTW 169* 142.93 NTW 270* 902.76 NTW 264 339.23 3.09** 5.8 MLU in Words 3.77** 7.62 2 Sample Story Retell Compared to Normative Sample 2 Sample Total Utterances 70* 37.95 MLU in Words 2.19** 5.8 MLU in Words MLU in Morphemes 2.40** 6.35 MLU in Morphemes 3.34** 6.35 MLU in Morphemes 4.16** 8.36 TTR .51* 0.34 TTR 0.41 0.34 TTR 0.41 0.46 Question Words 4* 1.2 Question Words 2 1.2 Question Words 1 0.6 Negatives Conjunctions 3* 9* 19.91 81.2 Negatives Conjunctions 2* 33 19.91 81.2 Negatives Conjunctions 2 22 4.16 36.96 Modal Auxiliary Verbs 2 6.73 Modal Auxiliary Verbs 0* 6.73 Modal Auxiliary Verbs 0 2.35 Personal Pronouns 21* 120.02 Personal Pronouns 29* 120.02 Personal Pronouns 41 35.02 1 1* 9* 10 0.39 11.72 4.53 6.35 Bound Morphemes Bound Morphemes /es /ed /ing /s 0* 0* 0* 6* 11.02 6.38 7.24 22.84 /es /ed /ing /s Bound Morphemes 0* 0* 5 10 11.02 6.38 7.24 22.84 * one devation from the mean, ** two deviations from the mean /es /ed /ing /s 74 Subject 3: Analysis Interview Picture Description Story Retell Interview Picture Description Story Retell Subject Total Utterances (Examiner) 101 (145) 81 (118) 110 (138) Conjunctions 4 4 2 MLU in Words 1.98 1.88 2.17 Modal Auxiliary Verbs 0 1 0 MLU in Morphemes 2.06 2 2.82 Semi-Auxiliary Elements 0 0 0 TTR 0.35 0.47 0.3 Personal Pronouns 34 7 21 2 1 2 NTW 200 152 239 Possesssive Pronouns & Determiners NDW 71 72 72 Reflexive Pronouns 0 0 0 18 4 9 Statements 53 (52.48%) 60 (74.07%) 79 (71.82%) Demonstrative Pronouns & Determiners Exclamations 3 (2.97%) 3 (3.70%) 13 (11.82%) Relative Pronouns in Utterances not ending in '?' 0 0 0 Questions 43 (42.57%) 17 (20.99%) 18 (16.36%) Universal Pronouns & Determiners 3 0 0 Responses to Questions 39 (38.61%) 31 (38.27%) 18 (16.35%) Partitive Pronouns & Determiners 0 0 0 Brown's Stage II II III Quantifying Pronouns & Determiners 0 2 0 Yes and No Words 15 6 4 Filled Pause Words 0 3 2 Word Type Frequency Question Words Negatives 43 7 17 9 18 2 75 Subject 3: Profile Analysis Interview Compared to Normative Sample 3 Sample Picture Description Compared to Normative Sample Total Utterances 101 124.91 Total Utterances NTW 200* 703.2 NTW Sample Story Retell Compared to Normative Sample 3 Sample 81 124.91 Total Utterances 110** 32.52 152* 703.2 NTW 239 272.1 1.88** 5.18 MLU in Words 2.17** 6.97 3 MLU in Words 1.98** 51.18 MLU in Words MLU in Morphemes 2.06** 5.69 MLU in Morphemes 2.0** 5.69 MLU in Morphemes 2.62** 7.6 TTR 0.35 0.37 TTR .47* 0.37 TTR .30** 0.47 Question Words 18** 1.6 Question Words 5* 1.6 Question Words 6** 0.48 Negatives 7 18.51 Negatives 9 18.51 Negatives 2 2.82 Conjunctions 4* 58.97 Conjunctions 4* 58.97 Conjunctions 2* 30.4 Modal Auxiliary Verbs 0* 6.69 Modal Auxiliary Verbs 1 6.69 Modal Auxiliary Verbs 0 1.18 Personal Pronouns 34 95.83 Personal Pronouns 7* 95.83 Personal Pronouns 21 27.33 0 0* 45** 1* 0.22 8.72 3.38 3.87 Bound Morphemes Bound Morphemes /es /ed /ing /s 0* 0 3 3* 9.11 5.06 3.97 2 /es /ed /ing /s Bound Morphemes 0* 2 3 0* 9.11 5.06 3.97 20 * one devation from the mean, ** two deviations from the mean /es /ed /ing /s 76 Subject 5: Analysis Interview Picture Description Story Retell Interview Picture Description Story Retell Subject Total Utterances (Examiner) 91 (101) 63 (82) 31 (92) Negatives 9 9 6 MLU in Words 4.08 4.25 4.58 Conjunctions 35 37 14 MLU in Morphemes 4.3 5.62 4.81 Modal Auxiliary Verbs 2 3 1 TTR 0.32 0.34 0.51 Personal Pronouns 59 36 17 NTW 371 268 142 Possesssive Pronouns & Determiners 24 3 3 NDW 117 91 73 Reflexive Pronouns 0 0 0 Statements 66 (72.53%) 54 (85.71%) 28 (90.32%) Demonstrative Pronouns & Determiners 14 9 6 Exclamations 1 (1.10%) 0 1 (3.23%) Relative Pronouns in Utterances not ending in '?' 0 0 0 Questions 24 (26.37%) 9 (14.29%) 1 (3.23%) Universal Pronouns & Determiners 0 0 0 Responses to Questions 33 (36.26%) 31 (49.21%) 8 (25.81%) Partitive Pronouns & Determiners 1 1 3 Brown's Stage Late V Post V Post V Quantifying Pronouns & Determiners 11 2 5 Question Words 19 (24) 7 (9) 0 (1) Yes and No Words 16 9 3 Filled Pause Words 1 0 0 Word Type Frequency 77 Subject 5: Profile Analysis Interview Compared to Normative Sample 5 Sample Picture Description Compared to Normative Sample Total Utterances 91** 191.41 Total Utterances NTW 393* 1007.72 NTW MLU in Words 4.08* 4.85 MLU in Morphemes 4.3 TTR Sample Story Retell Compared to Normative Sample 31 5 5 63** 275** 191.41 Total Utterances 1007.73 NTW 151 MLU in Words 4.25 4.85 MLU in Words 4.58 5.33 MLU in Morphemes 4.62 5.33 MLU in Morphemes 4.81 0.32 0.28 TTR 0.34 0.28 TTR 0.51 Question Words 22* 7.64 Question Words 9 7.46 Question Words 0 Negatives 9* 22.68 Negatives 9* 22.68 Negatives 6* Conjunctions 35 70.86 Conjunctions 37 70.86 Conjunctions 14 10.14 Modal Auxiliary Verbs 3* 10.14 Modal Auxiliary Verbs 1 Personal Pronouns 36** Personal Pronouns 17 Modal Auxiliary Verbs Personal Pronouns 2* 59* 141.05 Bound Morphemes Bound Morphemes /es /ed /ing /s 141.05 0* 1* 0* 2* 10.82 5.91 8 29.09 /es /ed /ing /s Sample 32.71 32.71 5.4 5.88 0.53 0.29 2.21 23.53 0.82 22.53 Bound Morphemes 0* 3 11 4* 10.82 5.91 8 29.09 * one deviation from the mean, ** two deviations from the mean /es /ed /ing /s 0 1 1 3 0.53 6.21 3.06 3.53 78 Subject 6: Analysis Interview Picture Description Story Retell Interview Picture Description Story Retell Subject Total Utterances (Examiner) 101 (146) 67 (117) 27 (104) Conjunctions 23 10 2 MLU in Words 2.65 2.66 2.59 Modal Auxiliary Verbs 0 0 0 MLU in Morphemes 2.73 2.76 2.7 Semi-Auxiliary Elements 0 0 0 TTR 0.39 0.46 0.66 Personal Pronouns 44 27 8 NTW 268 178 70 Possesssive Pronouns & Determiners 5 1 0 NDW 105 81 46 Reflexive Pronouns 0 0 0 Statements 82 (81.19%) 46 (68.66%) 20 (74.07%) Demonstrative Pronouns & Determiners 11 5 4 Exclamations 2 (1.98) 8 (11.94%) 1 (3.7%) Relative Pronouns in Utterances not ending in '?' 1 0 0 Questions 16 (15.84%) 8 (11.94%) 6 (22.22%) Universal Pronouns & Determiners 2 0 0 Responses to Questions 46 (45.54%) 22 (32.84%) 9 (33.33%) Partitive Pronouns & Determiners 0 1 0 Brown's Stage III III III Quantifying Pronouns & Determiners 0 8 2 Yes and No Words 27 10 0 Filled Pause Words 2 1 0 Word Type Frequency Question Words 4 (16) 1 (8) 3 (6) Negatives 18 2 0 79 Subject 6: Profile Analysis Interview Compared to Normative Sample 6 Sample Picture Description Compared to Normative Sample Total Utterances 101 120.37 Total Utterances NTW 274 763.52 NTW Sample Story Retell Compared to Normative Sample 6 Sample 67 115.27 Total Utterances 27 39.91 179* 759.29 NTW 71* 349.16 2.66** 5.63 MLU in Words 2.59** 7.46 6 MLU in Words 2.65** 5.41 MLU in Words MLU in Morphemes 2.73** 5.99 MLU in Morphemes 2.76** 6.24 MLU in Morphemes 2.70** 8.17 TTR 0.39 0.37 TTR .46** 0.37 TTR .66** 0.45 Question Words 5** 0.96 Question Words 1 0.81 Question Words 3** 0.67 Negatives 18 15.7 Negatives 2* 14.5 Negatives 0* 3.03 Conjunctions 23 63.85 Conjunctions 10* 65.71 Conjunctions 2* 38.81 Modal Auxiliary Verbs 0 6.48 Modal Auxiliary Verbs 0 5.56 Modal Auxiliary Verbs 0 2.45 Personal Pronouns 44 95.63 Personal Pronouns 27* 95.33 Personal Pronouns 8* 34.97 0 0* 0* 3 0.57 11.33 4.28 7.05 Bound Morphemes Bound Morphemes /es /ed /ing /s 0* 1 1* 3* 7.63 4.41 8.11 22.67 /es /ed /ing /s Bound Morphemes 0* 1 3 2* 8.29 5.08 8.44 22.44 * one deviation from the mean, ** two deviations from the mean /es /ed /ing /s 80 Subject 7: Analysis Interview Picture Description Story Retell Interview Picture Description Story Retell Subject Total Utterances (Examiner) 107 (112) 95 (66) 80 (83) Negatives 6 5 2 MLU in Words 3.91 4.61 5.42 Conjunctions 43 44 44 MLU in Morphemes 4.24 5.25 6.03 Modal Auxiliary Verbs 4 4 3 TTR 0.44 0.39 0.33 Semi-Auxiliary Elements 0 0 0 NTW 418 438 434 58 46 65 NDW 184 170 144 Personal Pronouns Possesssive Pronouns & Determiners 13 7 2 Statements 89 (83.18%) 82 (86.32%) 68 (85%) Reflexive Pronouns 0 0 0 Exclamations 2 (1.87%) 4 (4.21%) 6 (7.50%) Demonstrative Pronouns & Determiners 6 11 2 Questions 14 (13.08%) 5 (5.26%) 4 (5%) Relative Pronouns in Utterances not ending in '?' 0 1 4 Responses to Questions 20 (18.69%) 26 (27.37%) 2 (2.50%) Universal Pronouns & Determiners 3 2 0 Brown's Stage Late V Post V Post V Partitive Pronouns & Determiners 1 8 2 Quantifying Pronouns & Determiners 8 7 5 Yes and No Words 13 5 4 Word Type Frequency Question Words 4 (14) 2 (5) 1 (4) 81 Subject 7: Profile Analysis Interview Compared to Normative Sample 7 Sample Picture Description Compared to Normative Sample Total Utterances 107 149.52 Total Utterances NTW 424 908.08 NTW Sample Story Retell Compared to Normative Sample 7 Sample 95 149.52 Total Utterances 80** 33.03 451 908.08 NTW 434* 286.38 4.61 5.71 MLU in Words 5.43* 7.27 7 MLU in Words 3.91* 5.71 MLU in Words MLU in Morphemes 4.24* 6.26 MLU in Morphemes 5.25 6.26 MLU in Morphemes 6.03* 7.95 TTR .44* 0.33 TTR 0.39 0.33 TTR .33* 0.47 Question Words 5* 1.44 Question Words 2 1.44 Question Words 2* 0.51 Negatives 3** 0.79 Negatives 5* 21.08 Negatives 2 3.29 Conjunctions 43 80.1 Conjunctions 47 80.1 Conjunctions 44 31.92 Modal Auxiliary Verbs 4 7.54 Modal Auxiliary Verbs 5 7.54 Modal Auxiliary Verbs 3 1.68 Personal Pronouns 58 122.69 Personal Pronouns 47* 122.69 Personal Pronouns 65** 28.21 3** 22** 6 11* 0.16 9.37 3.65 5.29 Bound Morphemes Bound Morphemes /es /ed /ing /s 2 2 2 14 /es 10.33 1 10.33 /ed 6.4 3 6.4 /ing 6.85 20** 6.85 /s 23.67 11 23.67 * one deviation from the mean, ** two deviations from the mean Bound Morphemes /es /ed /ing /s 82 Subject 8: Analysis Interview Picture Description Story Retell Interview Picture Description Story Retell Subject Total Utterances (Examiner) 118 (115) 102 (72) 56 (82) Conjunctions 30 33 34 MLU in Words 4.3 4.99 5.41 Modal Auxiliary Verbs 11 7 3 MLU in Morphemes 4.6 5.53 5.8 Semi-Auxiliary Elements 0 0 0 TTR 0.34 0.34 0.48 Personal Pronouns 78 54 42 NTW 507 509 303 Possesssive Pronouns & Determiners 20 8 1 NDW 174 172 144 0 0 0 Statements 95 (80.51%) 82 (80.39%) 50 (89.29%) 18 38 6 Exclamations 3 (2.54%) 13 (12.75%) 1 (1.79%) Relative Pronouns in Utterances not ending in '?' 2 1 0 Questions 19 (16.10%) 6 (5.88%) 5 (8.93%) Universal Pronouns & Determiners 3 7 4 Responses to Questions 33 (27.97%) 17 (16.67%) 1 (1.79%) Partitive Pronouns & Determiners 1 8 1 Brown's Stage Post V Post V Post V Quantifying Pronouns & Determiners 7 4 3 Yes and No Words 13 8 2 Filled Pause Words 4 1 0 Word Type Frequency Question Words Negatives 7 (19) 9 6 (6) 11 0 (5) 3 Reflexive Pronouns Demonstrative Pronouns & Determiners 83 Subject 8: Profile Analysis Interview Compared to Normative Sample 8 Sample Picture Description Compared to Normative Sample Total Utterances 118 133.53 Total Utterances NTW 535 801.24 NTW Sample Story Retell Compared to Normative Sample 8 Sample 102 133.53 Total Utterances 56* 34.98 540 801.24 NTW 330 304.92 4.99 5.26 MLU in Words 5.41* 7.29 8 MLU in Words 4.3 5.26 MLU in Words MLU in Morphemes 4.6 5.77 MLU in Morphemes 5.53 5.77 MLU in Morphemes 5.80* 8.01 TTR 0.34 0.36 TTR 0.34 0.36 TTR 0.48 0.48 Question Words 11** 1.03 Question Words 6** 1.03 Question Words 1 0.47 Negatives 9 16.62 Negatives 11 16.62 Negatives 3 2.64 Conjunctions 30 70.03 Conjunctions 33 70.03 Conjunctions 34 33.4 Modal Auxiliary Verbs 11 6.74 Modal Auxiliary Verbs 7 6.74 Modal Auxiliary Verbs 3* 1.53 Personal Pronouns 78 102.32 Personal Pronouns 54 102.32 Personal Pronouns 42 28.75 0 7 2 6 0.55 10.57 3.53 6.26 Bound Morphemes Bound Morphemes /es /ed /ing /s 1* 0* 3 7* 8.65 5.62 5.59 21.35 /es /ed /ing /s Bound Morphemes 0* 8 16* 6* 8.65 5.62 5.59 21.35 * one deviation from the mean, ** two deviations from the mean /es /ed /ing /s 84 Subject 9: Analysis Interview Picture Description Story Retell Interview Picture Description Story Retell Subject Total Utterances (Examiner) 60 (111) 45 (75) 42 (94) Conjunctions 9 11 12 MLU in Words 3.67 4.39 4.25 Modal Auxiliary Verbs 2 1 0 MLU in Morphemes 4.05 5.08 4.6 Semi-Auxiliary Elements 0 0 0 TTR 0.45 0.54 0.44 Personal Pronouns 34 12 25 Possesssive Pronouns & Determiners 2 5 1 0 0 0 6 4 2 NTW 220 167 170 NDW 99 91 74 Statements 39 (65%) 40 (88.89%) 36 (85.71%) Exclamations 2 (3.33%) 2 (4.44%) 1 (2.38%) Relative Pronouns in Utterances not ending in '?' 0 0 0 Questions 19 (31.67%) 3 (6.67%) 3 (7.14%) Universal Pronouns & Determiners 0 1 1 Responses to Questions 33 (55.%) 24 (53.33%) 7 (16.67%) Partitive Pronouns & Determiners 0 1 3 Brown's Stage Late V Post V Post V Quantifying Pronouns & Determiners 3 2 1 Yes and No Words 9 2 4 Filled Pause Words 1 4 0 Word Type Frequency Question Words 11 (19) 1 (3) 2 (3) Negatives 14 2 4 Reflexive Pronouns Demonstrative Pronouns & Determiners 85 Subject 9: Profile Analysis Interview Compared to Normative Sample 9 Sample Picture Description Compared to Normative Sample Total Utterances 60* 142.93 Total Utterances NTW 225* 902.76 NTW Sample Story Retell Compared to Normative Sample 9 Sample 45* 142.93 Total Utterances 42 37.95 170* 902.76 NTW 175 339.23 4.39* 6.01 MLU in Words 4.25** 8.08 9 MLU in Words 3.67* 5.8 MLU in Words MLU in Morphemes 4.05* 6.35 MLU in Morphemes 5.08 6.58 MLU in Morphemes 4.60** 8.87 TTR .45* 0.34 TTR .54** 0.34 TTR 0.44 0.46 Question Words 12** 1.2 Question Words 1 1.18 Question Words 2* 0.6 Negatives 14 19.91 Negatives 2* 19.51 Negatives 4 4.11 Conjunctions 9* 81.2 Conjunctions 11* 75.84 Conjunctions 12* 36.12 Modal Auxiliary Verbs 2 6.73 Modal Auxiliary Verbs 1* 6.38 Modal Auxiliary Verbs 0 2.33 Personal Pronouns 34* 120.02 Personal Pronouns 12* 115.47 Personal Pronouns 25 34.54 0 6 0* 2* 0.39 11.51 4.47 6.3 Bound Morphemes Bound Morphemes /es /ed /ing /s 0* 2 2 5* 11.02 6.38 7.24 22.84 /es /ed /ing /s Bound Morphemes 2 0* 9 5* 10.73 6.16 7.04 22.4 * one deviation from the mean, ** two deviations from the mean /es /ed /ing /s 86 Subject 10: Analysis Interview Picture Description Story Retell Interview Picture Description Story Retell Subject Total Utterances (Examiner) 64 (95) 100 (80) 45 (87) Conjunctions 23 40 26 MLU in Words 5.31 5.18 4.64 Modal Auxiliary Verbs 1 7 3 MLU in Morphemes 5.75 5.69 4.96 Semi-Auxiliary Elements 0 0 0 TTR 0.45 0.37 0.5 50 59 20 NTW 313 518 209 19 35 8 NDW 140 194 105 0 1 0 Statements 56 (87.5%) 93 (93%) 42 (93.33%) Demonstrative Pronouns & Determiners 3 8 1 Exclamations 0 1 (1%) 0 Relative Pronouns in Utterances not ending in '?' 0 0 0 Questions 6 (9.38%) 5 (5%) 0 Universal Pronouns & Determiners 0 6 1 Responses to Questions 28 (43.75%) 38 (38%) 0 Partitive Pronouns & Determiners 2 2 0 Brown's Stage Post V Post V Post V Quantifying Pronouns & Determiners 4 13 2 Yes and No Words 9 13 3 Filled Pause Words 0 0 0 Word Type Frequency Question Words Negatives 1 (6) 8 0 (5) 13 0 (0) 3 Personal Pronouns Possesssive Pronouns & Determiners Reflexive Pronouns 87 Subject 10: Profile Analysis Interview Compared to Normative Sample 10 Sample Picture Description Compared to Normative Sample Total Utterances 64** 202 Total Utterances NTW 347** 1239.19 NTW Sample Story Retell Compared to Normative Sample 10 Sample 100** 202 Total Utterances 45 41.7 526* 1249.19 NTW 213* 383.92 5.18 5.62 MLU in Words 4.64** 8.07 10 MLU in Words 5.31 5.76 MLU in Words MLU in Morphemes 5.75 6.4 MLU in Morphemes 5.69 6.23 MLU in Morphemes 4.96** 8.89 TTR .45** 0.29 TTR .37** 0.28 TTR .50* 0.44 Question Words 4* 1.94 Question Words 2 1.94 Question Words 0 1 Negatives 8* 25.31 Negatives 13* 25.63 Negatives 0 0.82 Conjunctions 23* 104.25 Conjunctions 40* 111.38 Conjunctions 26 40.55 Modal Auxiliary Verbs 1* 9.44 Modal Auxiliary Verbs 7 9.81 Modal Auxiliary Verbs 3 2.45 Personal Pronouns 50* 154.94 Personal Pronouns 59* 162.81 Personal Pronouns 20* 39.95 0 3* 3 3* 0.88 14.05 5.95 7.2 Bound Morphemes Bound Morphemes /es /ed /ing /s 0* 2* 3* 10** 11.63 8.69 10.5 39.38 /es /ed /ing /s Bound Morphemes 4 4* 13 20* 12 8.75 10.69 39.69 * one deviation from the mean, ** two deviations from the mean /es /ed /ing /s 88 Appendix I Narrative Subject Scoring Descriptions Subject 1 Interview- subject 1 was rated as 2. Her story was well organized with a beginning, middle, and ending with some elaboration; however, it was only 5 T-units. Picture Description- subject 1 was rated as 1. Her story consisted of 3 T-units. There was a clear beginning with once upon a time, no climax, no elaboration and no clear ending. Story Retell- subject 1 was rated as better than 2 but not quite 3 because she produced a narrative with clear beginning and ending with fairly clear sequence of events; however, she did not elaborate and the climax was unclear. The majority of her sentences were very similar in form as they were simple sentences beginning with and, but, or then. Subject 2 Interview- subject 2 was rated as 1. She did not produce a narrative independently and needed clinician probes to elaborate on each statement. Picture Description- subject 2 was rated as better than 1 not quite 2 subcategory 4. Her sentences were often incomplete and her story was difficult to follow; however, it did have a weak beginning, a good climax and an ending. She used engaging gestures and facial expressions throughout the story. Story Retell- subject 2 was rated as 3. She had a detailed, engaging story with an emerging voice. It had several episodes, a beginning, middle, climax, and ending. Her sentence structure and organization needs some improvement. Subject 3 Interview- subject 2 was rated as narrative not present. She did not produce any utterances that resembled a narrative attempt. Picture Description- subject 3 was rated as 1. When probed for a narrative, she did not give a clear beginning, middle, or end. There was no climax or description and weak sentence structure. Story Retell- subject 2 was rated as better than 1 not quite 2 subcategory 1. Her story was in a logical sequence with characters. Sentence structure was weak, no clear climax. Subject 5 Interview- subject 5 was rated as 2 subcategory 1. His story had a clear beginning, middle and end but no climax and few details. Sentence structure contained errors. 89 Picture Description- subject 5 was rated as 2 subcategory 3. His story had a clear beginning, a climax, moderate description but unclear ending. Sentence structure was varied and contained some complex sentences but most had errors. Story Retell- subject 5 was rated as 2 subcategory 4. His story was disorganized but contained good descriptive segments. Sentence structure was varied but contained errors. After several probes, he produced a simple, cohesive story at the end; however, it took much effort to produce the narrative. Subject 6 Interview- subject 6 was rated as better than 2 subcategory 2 not quite 3. His story had a clear beginning, middle, and end with emerging detail. Sentence structure contained errors and the story only contained one episode. Picture Description- subject 6 was rated as 1. His story was disorganized with no clear beginning, middle or end and he needed probing to continue the narrative. His sentence structure was poor. Story Retell- subject 6 was rated as 2 subcategory 1. His story was somewhat organized and had a clear beginning, middle and end. There was no clear climax and few descriptors. Sentence structure was made up of simple sentences throughout. Subject 7 Interview- subject 7 was rated as 2 subcategory 2. Her story was very basic with a beginning, middle and end. It contained an undeveloped climax and one episode. Sentence structure was varied with few errors. Picture Description- subject 7 was rated as 3. Her story had clear parts with multiple episodes and some character development. Sentence structure was varied with some errors. There was some disorganization throughout. Story Retell- subject 7 was rated as better than 3 not quite 4. Her story had multiple elaborate episodes with varied sentence structure. It had a beginning middle and end with good climax. She used good expressions, gestures and intonation to tell her story; however, towards the end of the story there was some confusion with endings. Subject 8 Interview- subject 8 was rated as 2 subcategory 1. He told several short stories throughout this context. They were in more of a recount form but lacked a climax and descriptions. They were short, between 3-5 T-units. Sentence structure was varied and had good form with few errors. Picture Description- subject 8 was rated as better than 2 subcategory 4 but not quite 3. He told a few stories throughout this task. They tended to be a bit confusing as they were not always in logical order. However, there was a beginning and an end and his 90 sentences were varied in form with few errors and he was very descriptive in each story. Story Retell- subject 8 was rated as 4. He told a very detailed story with clear beginning, middle and end with a descriptive climax. His story was intriguing with an attempt at a story twist. Sentences were varied and had good structure with few to moderate errors. Subject 9 Interview- subject 9 was rated as 2 subcategory 1. She told short narratives with little description. They had a beginning, middle, end and a climax that was not well developed. Sentence structure was good with few errors. Picture Description- subject 9 was rated as 2 subcategory 1. She told her narratives tended to have a beginning but then just list events without a clear climax or ending. Sentence structure was good with some variation in form and there were few errors. Story Retell- subject 9 was rated as better than 2 subcategory 2 but not quite 3. She told a narrative with a clear beginning, middle with multiple episodes and an end but the climax was minimally developed and few descriptor words were used. Sentence structure was varied with moderate errors. Subject 10 Interview- subject 10 was rated as 3. He told descriptive narratives with a clear beginning, middle and end with a developed climax. His sentence structure was somewhat varied with some errors. Picture Description- subject was rated as 2 subcategory 4. His stories concerning the picture description task were somewhat unorganized but with good descriptions and characters. Story Retell- subject 10 was rated as 3. He used good descriptions. Sentence structure was varied with moderate errors. His story had a clear beginning, middle and end. The climax that could have been more developed. 91 VITA Katie Ellen Stilwell was born in Rogers, Arkansas on August 23, 1984, to Laura and Jim Stilwell. She was raised in Benton, Arkansas with her two younger siblings, Hunter and Leslie Stilwell. The majority of her education was received from the Benton Public School System and she graduated from Benton High School in 2002. From there she received a B.S. in Communication Disorders from the University of Arkansas in Fayetteville. Katie anticipates completion of a Master of Arts degree in SpeechPathology with a concentration in Aural Habilitation at the University of Tennessee in Knoxville in May 2008. Ms. Stilwell had the honor of receiving a grant entitled Multidisciplinary Literacy Project for Children who are Deaf or Hard of Hearing for the Fall 2007 and Spring 2008 terms in which she collaborated with deaf education, audiology and speech pathology graduate students to review and discuss issues and trends in the teaching of literacy to children who are deaf and hard of hearing. This experience, along with her dedication to Child Hearing Services greatly influenced Katie‟s interest in this population and her desire to complete a thesis on the topic of children who are hearing impaired.